Hemolysis due to aortic insufficiency following closure of ventricular septal defect

A two-year-old girl with ventricular septal defect (VSD) developed a severe degree of intravascular hemolysis following VSD closure. The cause of hemolysis was considered to be due to the aortic insufficiency (AI) jet against the VSD patch. The patient was reoperated on the seventh post-operative day. There was a small hole on the right coronary cusp, which was closed by five interrupted sutures. However, a third operation was performed on the following day because of the reappearance of AI. The use of pericardial flap to cover the whole right coronary cusp resulted in disappearance of hemolysis. The patient was discharged in a satisfactory condition.