Thrombotic microangiopathy in a very young infant with mitral valvuloplasty

Yuka Matsunaga, masataka ishimura, Hazumu Nagata, Kiyoshi Uike, Tadamune Kinjo, Masayuki Ochiai, Kenichiro Yamamura, Hidetoshi Takada, Yoshihisa Tanoue, Masaki Hayakawa, Masanori Matsumoto, Toshiro Hara, Shoichi Ohga

Research output: Contribution to journalArticle

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Abstract

Background: Thrombotic microangiopathies (TMA) are microvascular occlusive disorders characterized by systemic or intrarenal platelet aggregation, thrombocytopenia, and red cell fragmentation. Post-operative TMA mostly occurs in adult patients with cardiovascular surgery, with the distinct pathophysiology from classical thrombotic thrombocytopenic purpura (TTP) although the exact pathophysiology remains unclear. Case presentation: A one-month-old infant developed TMA after the initial surgery of double outlet right ventricle. ADAM metallopeptidase with thrombospondin type 1 motif 13 (ADAMTS13) activity was sustained (64%) with the undetectable inhibitor. Von Willebrand factor (VWF) multimer analyses showed absent high-molecular weight multimers. Echocardiography disclosed severe mitral regurgitation. The mitral valve repair 32 days after the initial valvuloplasty led to prompt resolution of TMA. These suggested that TMA occurred in association with valvulopathy-triggered turbulent shear flow, mechanical hemolysis and endothelial damage. The consumption of large VWF multimers might account for the vascular high shear stress shown in Heyde syndrome. Conclusion: The youngest case of post-operative TMA underscores the critical coagulopathy after the first surgical intervention for congenital heart disease.

Original languageEnglish
Pages (from-to)595-599
Number of pages5
JournalPediatrics and Neonatology
Volume59
Issue number6
DOIs
Publication statusPublished - Dec 1 2018

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Thrombotic Microangiopathies
von Willebrand Factor
Double Outlet Right Ventricle
Thrombospondin 1
Thrombotic Thrombocytopenic Purpura
Mitral Valve Insufficiency
Metalloproteases
Hemolysis
Mitral Valve
Platelet Aggregation
Thrombocytopenia
Statistical Factor Analysis
Blood Vessels
Echocardiography
Heart Diseases
Molecular Weight

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

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Thrombotic microangiopathy in a very young infant with mitral valvuloplasty. / Matsunaga, Yuka; ishimura, masataka; Nagata, Hazumu; Uike, Kiyoshi; Kinjo, Tadamune; Ochiai, Masayuki; Yamamura, Kenichiro; Takada, Hidetoshi; Tanoue, Yoshihisa; Hayakawa, Masaki; Matsumoto, Masanori; Hara, Toshiro; Ohga, Shoichi.

In: Pediatrics and Neonatology, Vol. 59, No. 6, 01.12.2018, p. 595-599.

Research output: Contribution to journalArticle

Matsunaga, Yuka ; ishimura, masataka ; Nagata, Hazumu ; Uike, Kiyoshi ; Kinjo, Tadamune ; Ochiai, Masayuki ; Yamamura, Kenichiro ; Takada, Hidetoshi ; Tanoue, Yoshihisa ; Hayakawa, Masaki ; Matsumoto, Masanori ; Hara, Toshiro ; Ohga, Shoichi. / Thrombotic microangiopathy in a very young infant with mitral valvuloplasty. In: Pediatrics and Neonatology. 2018 ; Vol. 59, No. 6. pp. 595-599.
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AU - Kinjo, Tadamune

AU - Ochiai, Masayuki

AU - Yamamura, Kenichiro

AU - Takada, Hidetoshi

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AU - Ohga, Shoichi

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