Mechanical Hemolysis after Mitral Valve Repair: Report of a Case

A 60-year-old man underwent aortic valve replacement with a bileaflet mechanical valve for aortic regurgitation and mitral valve repair using a prosthetic ring for mitral regurgitation (MR). Intraoperative transesophageal echocardiography (TEE) confirmed no residual MR and a normally functioning aortic prosthetic valve without a paravalvular leak. One week after the operation, transthoracic echocardiography showed trivial MR. Two weeks later, in addition to elevation of a lactate dehydrogenase value and schistocytosis, TEE revealed mild MR with a high velocity jet that collided with the prosthetic ring. However, structural and non-structural abnormalities of the aortic mechanical valve such as para-valvular leakage were not detected on TEE. Subsequent to failed medical treatment for hemolysis, reoperation for the mitral valve was performed. At reoperation, the mitral valve repair was intact, and the cause of failed valve repair was thought to be residual MR. Mitral valve replacement with a mechanical valve led to immediate cessation of hemolysis.