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You are here: Contents > 2016 > Volume 25 Number 4 July 2016 > CASE REPORTS > New-Onset Hemolytic Anemia after Percutaneous Paravalvular Leak Closure

New-Onset Hemolytic Anemia after Percutaneous Paravalvular Leak Closure

Luís Almeida-Morais1,2, António Fiarresga1, Duarte Cacela1, Lídia de Sousa1, Ana Galrinho1, Rui Rodrigues1, Lurdes Ferreira1, Rui Ferreira1

1Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal
2Electronic correspondence:

Background and aim of the study: Despite being usually clinically silent, paravalvular leak can present with congestive heart failure (CHF) or haemolytic anemia. Here, the case is reported of a paravalvular leak presenting with CHF, complicated by new-onset severe hemolytic anemia after percutaneous closure with a large ventricular septal duct (VSD) occlude device.

Methods: A 57-year-old patient presented with infectious endocarditis of a native mitral valve with major mitral regurgitation and was submitted for mitral valvuloplasty. However, one month later failure of the valvuloplasty forced the need for mechanical prosthetic valve implantation. Early endocarditis of the mechanical valve with CHF was noted two months later and led to mechanical valve substitution. One year later the patient presented with a major paravalvular leak and CHF recurrence. Hence, percutaneous paravalvular leak closure was proposed.

Results: A 16-mm VSD occluder was used, and clinical

and echocardiography success was noticed. However, new-onset hemolytic anemia with acute kidney injury forced surgical re-intervention, with the successful implantation of a third mechanical valve.

Conclusion: Usually, percutaneous paravalvular leak closure is a safe and successful method to treat high-risk surgical patients. However, hemolytic anemia may develop after a technically successful procedure, forcing surgical intervention. Dedicated devices are needed to overcome this important safety issue.

Video 1: Periprocedural acquisition of 3-D transesophageal echocardiography showing two AVP II in the left atrium after unsuccessful deployment.

Video 2: Periprocedural imaging of a muscular ventricular septal duct (mVSD) occluder (16 mm), with successful closure of the paravalvular leak.

The Journal of Heart Valve Disease 2016;25:494-497

New-Onset Hemolytic Anemia after Percutaneous Paravalvular Leak Closure

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