Refractory hemolytic anemia secondary to perivalvular leak diagnosed by transesophageal echocardiography

Transesophageal echocardiography (TEE) has become increasingly important in the assessment of mitral valve prosthetic dysfunction. We report on three patients who developed medically refractory hemolytic anemia after St. Jude mitral valve replacement secondary to perivalvular mitral prosthetic regurgitation. Two of the three cases had corrective surgical intervention that resolved the hemolytic process. Careful transesophageal echocardiographic evaluations of the perivalvular area proved diagnostic and resulted in appropriate management decisions.