Haemolytic Anemia due to Paravalvular Leak Following Mitral and Aortic Valves Replacement

Arif Ali ,Azhar Mehmood Kayani,Agha Babar Hussain,Muhammad Usman Ali

doi:10.4172/2329-9517.1000308

Abstract

Background: Paravalvular leak (PVL) can complicate mitral and aortic valves replacement. Most PVLs are often clinically insignificant. However, large leaks can lead to heart failure and infective endocarditis. Intravascular hemolytic anemia is common in small PVLs. Reoperation for closure of PVL is associated with high mortality. Transcatheter closure is less invasive and can be used in high-risk patients. Case summary: We present a case of a 38-year-old man with a history of Aortic Valve replacement (AVR) and Mitral valve replacement (MVR) who developed hemolytic anemia and haemoglobinurea. The patient was managed initially conservatively but later underwent redo valve surgery after exclusion of other causes of hemolytic anemia. Postoperatively, haemoglobinurea disappeared dramatically whereas anemia resolved gradually after surgery. Discussion: Significant intravascular hemolysis is a rare but serious complication of PVL that poses diagnostic problem to cardiac surgeons, but also for cardiologists and internal medicine professionals especially when the prosthetic valve function is considered adequate. PVL is the flow of blood through a track between the native cardiac tissue and the implanted valve due to any compromise in closure between the two. PVL is also more frequently seen after mitral (up to 20%) valve replacement than aortic prosthetic valves. PVLs are more frequently diagnosed by Transesophageal echocardiography (TEE) than Transthoracic echocardiography (TTE) due to its ability to detect minute jets of regurgitated blood. Conclusion: Either repair or re-replacement of prosthetic valves with PVLs is needed in about 1% to 5% of patients. The case study is presented to highlight PVL as a rare cause of haemoglobinurea and hemolytic anemia.

Highlights

DiscussionSignificant intravascular hemolysis is a rare but serious complication of Paravalvular leak (PVL) that poses diagnostic problem to cardiac surgeons, and for cardiologists and internal medicine professionals especially when the prosthetic valve function is considered adequate
Paravalvular leak (PVL) is an alarming complication after placement of cardiac valves
Either repair or re-replacement of prosthetic valves with PVLs is needed in about 1% to 5% of patients

Summary

Discussion

Haematuria is a common symptom with several differentials in its diagnosis. Often it is difficult to diagnose its exact etiology and needs detailed work up [9]. Redo surgery with replacement of mechanical mitral and aortic valves with bioprosthetic prosthetic valves Post operatively, his urine routine examination was normal. TEE at mid Esophageal level of our patient shows aortic prosthesis in short axis with clearly abnormal flow outside the sewing ring causing regurgitation from aorta to left ventricle evident from one to 3 O Clock position (Video 2) Transesophageal Echo at mid oesophageal level along with M mode showing aortic mechanical valve in situ with significant leak above the mechanical valve disc clearly shown in M mode and 2 D mode from 1 to 3 o’clock position (Figure 1). Transthoracic echocardiography and transesophageal echocardiography of our patient showed mild leak at mitral valve and moderate paraprosthetic leak from mechanical aortic valve. Transcatheter approach involves deployment of occluder devices or coils and adopting either a percutaneous or a transapical approach

Conclusion

Introduction

Findings