Mitral edge-to-Edge repair resolves hemolytic anemia after mitral valve repair

J. K. Scheffler (Ulm)¹, S. Schönsteiner², A. Hanrieder², L. Schneider (Ulm)¹, D. Felbel (Ulm)¹, J. Mörike (Ulm)¹, W. Rottbauer (Ulm)¹, M. Paukovitsch (Ulm)^1
1Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; ²

Background: Hemolytic anemia after surgical valve repair is rare but potentially life-threatening and is mostly described in the context of paravalvular regurgitation.
Case Summary: A 78-year-old women with prior surgical mitral valve repair using ring annuloplasty and neochordae implantation presented with progressive fatigue, dyspnea and laboratory evidence of severe hemolytic anemia. Further laboratory work-up ruled out autoimmunhemolytic anemia.
Transthoracic and transesophageal echocardiography revealed severe eccentric, valvular mitral regurgitation caused by anterior leaflet prolapse with a high-velocity regurgitant jet striking the annuloplasty ring. The patient underwent successful transcatheter mitral edge-to-edge repair (M-TEER), achieving reduction of mitral regurgitation to mild and resolution of hemolysis.
Discussion: This case highlights the importance of hemolysis due to valvular regurgitation as rare complication after surgical mitral valve repair and the utility of M-TEER as a re-do strategy for patients at prohibitive surgical risk.
Take-Home Message: M-TEER is a safe and effective option for managing hemolytic anemia induced by recurrent MR after surgical repair. Besides paravalvular regurgitation, valvular regurgitation in the context of prior surgical MV repair should be recognized as a potential cause of hemolytic anemia.