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Published on: December 11, 2017
Symptomatic anaemia 17 years after double valve replacement
1Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia. drwongmh@gmail.com
Singapore Medical Journal
|November 13, 2009
Summary
A patient experienced severe anemia due to mitral valve paravalvular leakage 17 years after prosthetic valve replacement. A second mitral valve replacement successfully resolved the hemolytic anemia.
Area of Science:
- Cardiology
- Hematology
- Biomedical Engineering
Background:
- Prosthetic heart valves, including Starr-Edwards and Bjork-Shiley devices, are used to treat valvular heart disease.
- Long-term complications of prosthetic valves can include paravalvular leakage and hemolysis.
- Hemolytic anemia is a potential complication following valve replacement surgery.
Observation:
- A 40-year-old woman presented with severe anemia (hemoglobin 7.8 g/dL) and symptoms of heart failure 17 years post-mitral and aortic valve replacement.
- Biochemical markers indicated intravascular hemolysis: elevated lactate dehydrogenase (2,057 IU/L), high reticulocyte count (8.4%), and low haptoglobin (<6 mg/dL).
- Transesophageal echocardiography identified significant paravalvular leakage around the mitral prosthesis.
Findings:
- The patient's persistent anemia was refractory to blood transfusions, suggesting a continuous hemolytic process.
- The paravalvular mitral leak was identified as the likely cause of the intravascular hemolysis.
- Surgical intervention with a second mitral valve replacement was performed.
Implications:
- This case highlights the importance of considering prosthetic valve dysfunction, specifically paravalvular leakage, in patients presenting with unexplained hemolytic anemia.
- Timely diagnosis and surgical management of paravalvular leaks are crucial for resolving prosthetic valve-related hemolytic anemia.
- Long-term monitoring of patients with mechanical heart valves is essential for early detection of complications.
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