Malaise and fatigue following mitral valve repair: case report

INTRODUCTION: Mitral valve regurgitation is the second most common valvular heart disease. In primary, degenerative mitral regurgitation (MR), valve repair is the preferred treatment option. CASE PRESENTATION: We present a case of a 73-year-old man who was admitted to our cardiology department with progressively worsening shortness of breath (New York Heart Association-Classification IV) and fatigue 2 months after surgical mitral valve repair for MR. Transthoracic and transoesophageal echocardiography showed a remaining severe MR and mitral valve stenosis II°. Laboratory results showed an extra-corpuscular, mechanical, and haemolytic anaemia. After exclusion of other causes of haemolytic anaemia and the lack of clinical and laboratory improvement, the patient underwent valve replacement with a biological valve. Haemolysis parameter normalized and the clinical status improved. DISCUSSION: Although haemolysis after mechanical prosthetic mitral valve replacement is frequently recognized, haemolytic anaemia after mitral valve reconstruction is still an underestimated complication, and there are only a small number of reported cases. This case demonstrates the clinical diagnostic steps for excluding other causes of haemolytic anaemia after mitral valve repair in patients with a history of heart surgery.