Time Does Not Heal All Ills: The Late Occurrence of Hemolytic Anemia After Prosthetic Mitral Valve Replacement

Hemolytic anemia is a well-known complication of prostheses following the replacement of cardiac valves. Therefore, in all patients with prosthetic valve placement who present with anemia or hyperbilirubinemia, hemolysis is an important differential that must be ruled out, irrespective of how long the valve replacement has lasted. Indications for repair either through percutaneous or surgical approach generally include the severity of hemolysis based on either persistent symptoms of fatigue, the continued requirement of blood transfusions, or else the progression of valvular dysfunction. However, if hemoglobin remains stable, symptoms resolve, there is minimal functional impairment, or the risk of comorbidities is greater than the benefits of invasive intervention, then an initial trial of medical therapy is prudent. Our case report is unique as it demonstrates the late occurrence of symptomatic severe hemolytic anemia more than 20 years after valvular replacement. It also offers an alternative approach to invasive management in patients who develop this complication after such a prolonged asymptomatic period.