[Preoperative mechanical hemolysis in triple rheumatic valve disease. Apropos of 1 case]

A 25-year-old Senegalese woman with severe multivalvular disease presented with jaundice (unconjugated bilirubin) augmented by exertion without evidence of frank anemia. Following the exclusion of all other causes of hemolysis, the diagnosis of mechanical hemolysis secondary to deformed valves was established. The jaundice and laboratory evidence of hemolysis diminished markedly after placement of (Starr) aortic and mitral valve prostheses and a tricuspid commissurotomy. While chronic hemolysis due to ball or disc valve prostheses is usually clinically insignificant yet often described in the literature, hemolysis complicating non-operated valvulopathies is a rare clinical condition and, in contrast to the case presented, usually less severe than hemolysis following valve prosthesis insertion.