The utility of point-of-care transesophageal echocardiography in intensive care unit for detecting the cause of hemolytic anemia after ascending aorta replacement

Abstract Hemolysis is well known as a complication after mitral valve surgery, and hemolytic anemia after valvular surgery in the intensive care unit (ICU) usually orients ICU physicians to a careful imaging examination. However, hemolytic anemia following aortic replacement has rarely been described and little is known. We present a case of hemolytic anemia after ascending aortic replacement for type A aortic dissection repair. In the case, transthoracic echocardiography (TTE), contrast-enhanced computed tomography (CT), and laboratory tests failed to identify the cause of hemolytic anemia. Transesophageal echocardiography (TEE) finally revealed a stenosis of the proximal anastomosis of the graft with turbulent flow due to protrusion into the lumen. This finding was speculated to represent the cause of hemolysis and was sufficient to convince the surgeons to repair the lesion. In the repair surgery, inversion of the inner felt strip that had been applied to the proximal anastomosis of the replacement ascending aorta was confirmed as shown with TEE, and the constricted anastomosis was repaired. Although TTE and CT have been generally used to identify the lesion of mechanical hemolysis after cardiac surgery, point-of-care TEE could promptly identify the causative lesion in the present case. Point-of-care TEE in the ICU could become a first-line imaging examination for the postoperative hemolysis in cardiac patients.