Perioperative evaluation of primary hemostasis in patients undergoing mitral valve repair

摘要

Acquired von Willebrand syndrome in high intracardiac shear stress conditions, such as aortic stenosis [1,2,3,4,5,6,7,8], ventricular septal defect [9] and patent ductus arteriosus [10], has been clearly defined in its epidemiology, pathophysiology and clinical correlations. Similarly, patients with other cardiac defects might occasionally exhibit such abnormality. Platelet and blood clotting activation has been shown in patients with mitral valve prolapse but no data exist on the prevalence of primary hemostatic defects and acquired von Willebrand disease in mitral valve prolapse with severe regurgitation [11]. The fluid dynamics of a regurgitant valve are, in many ways, similar to the fluid dynamics of a stenotic valve; however, the anatomy of the regurgitant orifice and the dynamics of the regurgitant flow are complex and not fully understood. The shape and the direction of the regurgitant jet depends on multiple factors, including the anatomy and orientation of the regurgitant orifice, the driving force across the valve, and the size and compli-ance of the receiving chamber. Given these facts, we hypothesized that primary hemostasis defects could be a feature in patients with mitral valve prolapse. Aim of this study was to evaluate the prevalence of primary hemostasis disorders in patients with severe mitral regurgitation due to prolapse without an history of pathological mucocutaneous bleeding, by means of PFA-100 and to define their pathophysiology and clinical implications.