Severe hemoglobinuria masquerading as gross hematuria following mitral valve replacement

Gross hemoglobinuria following mitral valve replacement can represent a rare form of hemolytic anemia. This condition can masquerade as gross hematuria in the post-valve replacement patient. It is commonly associated with valvular dysfunction, specifically, perivalvular leakage. The leakage may not be apparent on routine echocardiography but it may be documented with trans-esophageal echocardiography.