Hematuria in an Adult with Congenital Heart Disease

Area of Science:

• Cardiology
• Emergency Medicine
• Urology

Background:

• Adult congenital heart disease (CHD) is increasing due to improved medical and surgical management.
• Adults with CHD may present to the emergency department (ED) with nonspecific complaints after cardiac interventions.
• Unforeseen complications can arise from cardiac interventions in adults with CHD.

Observation:

• A 39-year-old male presented to the ED with hematuria and dysuria 10 days post-percutaneous ventricular septal defect (VSD) device closure.
• Initial evaluation revealed a urinary tract infection and hematuria.
• Persistent symptoms and anemia led to the diagnosis of intravascular hemolysis.

Findings:

• Cardiac catheterization identified residual shunting through the VSD device margins as the cause of hemolysis.
• Hematuria and dysuria were atypical presenting symptoms for this rare complication.
• Intravascular hemolysis secondary to VSD device closure is a rare but significant complication.

Implications:

• Emergency physicians must consider rare complications in adults with CHD presenting with unusual symptoms.
• A multidisciplinary approach is crucial for diagnosing and managing complex CHD cases in the ED.
• Prompt recognition of intravascular hemolysis is vital for appropriate treatment and patient outcomes.