Hemolytic anemia due to a periprosthetic leak is a rare complication of valve replacement that has a poor prognosis. Herein are reported the details of two women (aged 62 and 74 years) who had undergone mitral valve surgery four times each; in both cases, a fifth operation was performed because of hemolytic anemia due to periprosthetic leak. An anterior repair of the leaks was performed instead of re-replacing the

valve or standard repair, because the extensively calcified annulus led to sufficient space, and viable tissue was available to place direct sutures. Both patients made a rapid and uneventful recovery, with satisfactory short-term results; however, the long-term outcomes remain uncertain.

The Journal of Heart Valve Disease 2007;16:132-135