[Severe Hemolytic Anemia Due to Paravalvular Leak Associated with Heart Failure and Congestive Hepatopathy: A Case...

Chronic heart failure can cause hepatic fibrosis. Although the patho-physiological mechanisms are well described, diagnosing the underlying cause and functional deterioration remains complex. We present the case of a 72-year-old woman with a history of double bioprosthetic valve replacement who presented with acute right heart failure de-compensation. Uncontrolled atrial fibrillation, liver dysfunction, and hemolytic anemia were observed. A transesophageal echocardiogram revealed severe tricuspid regurgitation and mitral valve replacement dysfunction, with a paravalvular leak causing intravascular hemolysis. After ruling out infectious causes and assessing prosthetic valve function, hepatic fibrosis associated with venous congestion due to right ventricular dysfunction and severe tricuspid regurgitation was diagnosed. The surgical option was excluded, and heart failure was treated with diuretics and neurohormonal blockade, leading to symptom resolution. This case highlights the importance of integrating clinical and paraclinical findings for an accurate diagnosis.