Relationship Between Intravascular Hemolysis and Bright Sparkling Echoes Detected by TEE in the Vicinity of Mechanical Mitral Prosthesis

The significance of abnormal bright and sparkling echoes in patients with mechanical mitral prosthetic valves (MMPV) has yet to be established. In the present study, the incidence of this phenomenon and its relationship with hemolysis was evaluated. Thirty-five consecutive patients with MMPV, each examined by transesophageal echocardiography (TEE), were divided into four groups: (1) no bright echoes (n = 11 patients); (2) minor echoes (+) (n = 11 patients); (3) moderate echoes (++) (n = 7 patients); and (4) numerous echoes (+++) (n = 6 patients). Hemolysis was evaluated from assays of serum haptoglobin, serum lactic dehydrogenase (LDH) and hydrobutyric dehydrogenase (HDH), plasma hemoglobin, indirect bilirubin, and LDH1 and LDH2 isoenzymes. Serum haptoglobin was significantly lower in the patients with bright echoes (0.17 vs 0.63; P < 0.05). In patients with (++) and (+++) bright echoes, the plasma hemoglobin levels and indirect bilirubin levels were significantly higher than the levels found in those patients with minor echoes or with no echoes. These results suggest that bright echoes in patients with MMPV are related to intravascular hemolysis, and the more intense the echo the more severe the hemolysis. Furthermore, there was a higher incidence of bright echoes in the patients with bileaflet prosthetic valves than in those fitted with the Björk valve (84.6% vs 22%). (ECHOCARDIOGRAPHY, Volume 13, July 1996)