Valvular Hemolysis Masquerading as Prosthetic Valve Stenosis

Abstract

The evaluation of prosthetic valves can provide a unique challenge, and a thoughtful approach is required. High output states like anemia should be kept in the differential when evaluating elevated gradients across prosthetic valves. We present the case of a 69-year-old man with a Starr-Edwards prosthetic aortic valve who presented with symptoms of congestive heart failure and high transvalvular pressure gradients. These symptoms indicate a potential prosthetic valve stenosis. His laboratory evaluation results were consistent with valve-related hemolysis. Resolving his anemia led to a resolution of the symptoms and lowered the pressure gradient on follow-up.

Simultaneous Aortic Valve-in-Valve and Ascending Stent Grafting for Prosthetic Valve Stenosis and Ascending Flap

“… 2 , 3 ) In contrast, significant AS notably reduced hemoglobin and haptoglobin levels and increased LDH levels, 5 ) indicating that AS also potentially causes hemolysis. 1 , 5 ) Second, the patient had symptomatic severe AS requiring re-AVR, of which staged stent grafting following implantation of the EvolutR valve, which was the only approved valve for valve-in-valve in Japan at that time, could not be performed because the high frame of the EvolutR valve would interfere with the proximal landing zone. Therefore, we considered it reasonable to perform simultaneous intervention for prosthetic valve deterioration and ascending flap to treat both the congestive heart failure and possible causes of the hemolysis.…”

“…Hemolytic anemia is a rare but possible complication both after aortic valve replacement (AVR) 1 ) and ascending aortic replacement. 2 , 3 ) Reoperative replacement of the aortic valve and the ascending aorta has significant surgical mortality and morbidity, making less invasive approach desirable for high-surgical-risk patients.…”