Hemolytic Anemia after Aortic Valve Replacement: a Case Report
Hemolytic anemia is exceedingly rare and an underestimated complication after aortic valve replacement (AVR).The mechanism responsible for hemolysis most commonly involves a regurgitated flow or jet that related to paravalvar leak or turbulence of subvalvar stenosis. It appears to be independent of its severity as assessed by echocardiography. We present a case of a 24-year-old man with a history of AVR in 10 year ago that developed severe hemolytic anemia due to a mild subvalvar stenosis caused by pannus formation and mild hypertrophic septum. After exclusion of other causes of hemolytic anemia and the lack of clinical and laboratory improvement, the patient underwent redo valve surgery with pannus and subvalvar hypertrophic septum resection. Anemia and heart failure symptoms gradually resolved after surgery.
Ross JC, Hufnagel CA, Fries ED, et al. The hemodynamic alterations produced by plastic valvular prosthesis for severe aortic insufficiency in man. J Clin Invest 1954;33(6):891-900.
Sayed HM, Dacie JV, Handley DA, et al. Haemolytic anaemia of mechanical origin after open heart surgery. Thorax 1961;16(4):356-60.
Rajiv M, Larry J, Alfred I, et al. Evaluation of hemolysis in patients with prosthetic heart valves. Clin Cardiol 1998;21(6):387-92 .
Mestres C. Intravascular hemolysis after mitral valve repair: a word of caution. Eur J Cardiothoracic Surg. 1992;6(2):103-5 .
Inoue M, Kaku B, Kanaya H, et al. Reduction of hemolysis without reoperation following mitral valve repair. Circ J 2003;67(9):799-801.
Blackshear PL Jr, Dorman FD, Steinbach JH, Maybach EJ, Singh A, Collingham RE: Shear wall interaction and hemolysis. Trans Am Soc Artif Intern Organs 1966;12(2):113-20.
Nevaril CG, Lynch EC, Alfrey CP, et al. Erythrocyte damage and destruction induced by shearing stress. J Lab Clin Med 1968;71(5):784-90.
Okumiya T, Ishikawa-Nishi M, Doi T, et al. Evaluation of intravascular hemolysis with erythrocyte creatine in patients with cardiac valve prostheses. Chest 2004;125(6):2115-20.
Suedkamp M, Lercher AJ, Mueller-Riemenschneider F, et al. Hemolysis parameters of St. Jude Medical: Hemodynamic Plus and Regent valves in aortic position. Int J Cardiol 2004;95(1):89-93.
Astapov DA, Zheleznev SI, Semenova EI. A case of severe intravascular hemolysis after double mechanical heart valve implantation. Kardiologiia 2013;53(5):94-5.
Mecozzi G, Milano AD, De Carlo M, et al. Intravascular hemolysis in patients with new-generation prosthetic heart valves: a prospective study. J Thorac Cardiovasc Surg 2002;123(3):550-6.
Lund O, Emmertsen K, Nielsen TT, et al. Impact of size mismatch and left ventricular function on performance of the St. Jude disc valve after aortic valve replacement. Ann Thorac Surg 1997;63(5):1227-34.
Grobéty M, Venetz JP, Genton CL, et al. Malfunction of a mitral bioprosthesis, hemolysis and acute renal insufficiency. Schweiz Med Wochenschr 1995;125(36):1679-83.
Skoularigis J, Essop MR, Skudicky D, et al. Frequency and severity of intravascular hemolysis after left-sided cardiac valve replacement with Medtronic Hall and St. Jude Medical prostheses, and influence of prosthetic type, position, size and number. Am J Cardiol 1993;71(7):587-91.
Yuda T, Morishita Y, Arikawa K, et al. Intravascular hemolysis after prosthetic valve replacement. Nihon Kyobu Geka Gakkai Zasshi 1990;38(2):270-4.
Febres-Roman PR, Bourg WC, Crone RA, et al. Chronic intravascular hemolysis after aortic valve replacement with Ionescu-Shiley xenograft: comparative study with Bjork- Shiley prosthesis. Am J Cardiol 1980;46(5):735-8.
Heilmann E, Bender F, Tasche V. Proceedings: Studies on mechanically induced hemolysis following prosthetic heart valve replacement. Schweiz Med Wochenschr 1975;105(51):1790-1.
Slater SD, Prentice CR, Bain WH, et al. Fibrinogen-fibrin degradation product levels in different types of intravascular haemolysis. Am J Clin Pathol 1973;3(5878):839-42.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.