Symptomatic anaemia 17 years after double valve replacement

• Main Authors: Wong, M.H., Chee, K.H., Azman, W.
• Format: Article
• Published: Stamford Publishing Pte Ltd / Singapore Medical Association 2009
• Subjects: R Medicine
• Online Access: http://eprints.um.edu.my/1176/; http://www.ncbi.nlm.nih.gov/pubmed/19907876
• Institution: Universiti Malaya

A 40-year-old Malay woman presented with increasing lethargy, palpitation and shortness of breath, 17 years after a mitral and aortic valve replacement. A Starr-Edwards prosthetic valve replaced the mitral valve, and a Bjork-Shiley prosthetic valve replaced the aortic valve. Biochemical parameters demonstrated intravascular haemolysis, as evidenced by haemoglobin 7.8 g/dL, reticulocyte count 8.4%, lactate dehydrogenase 2,057 IU/L and low haptoglobulin levels (less than 6 mg/dL). Transoesophageal echocardiography revealed a paravalvular leakage over the mitral valve. The haemoglobin levels remained persistently low despite frequent blood transfusions. She successfully underwent a second mitral valve replacement. Her anaemia resolved subsequently.