Hemolysis After Mitral Annuloplasty Ring With Residual Mild Mitral Regurgitation

Abstract

Hemolysis is a rare complication of prosthetic-ring annuloplasty surgery. We report a patient admitted to our institution for hematuria and renal insufficiency. He had undergone mitral annuloplasty for severe mitral regurgitation and tricuspid annuloplasty 3 months ago. Admission laboratory values included hemoglobin 5.4 g/dL, hematocrit 16%, creatinine 1.85 mg/dL, and a schistocyte count of 5.5% (normal value below 1%). As part of the patient's work up, his mitral valve function was assessed using transesophageal echocardiography (TEE) which revealed the presence of mild mitral regurgitation with an eccentric regurgitant jet impinging on the annulus. Assuming the cause of hemolysis was an eccentric mitral regurgitation jet directly hitting the annulus after a thorough workup ruled out other potential etiologies, the patient was scheduled to undergo surgical mitral bioprosthetic valve replacement. Complete resolution of hemolysis postoperatively helped confirm that the patient's hemolysis had been caused by the eccentric mitral regurgitant jet, which was impinging on the mitral annuloplasty ring. It was a rare case of hemolysis after mitral annuloplasty ring with residual mild mitral regurgitation.