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J Thorac Cardiovasc Surg 2010;140:e35-e36
© 2010 The American Association for Thoracic Surgery

Brief Clinical Report

Explantation of a 44-year-old Starr–Edwards mitral valve for delayed hemolysis

Joss Fernandez, MD, Robert Saeid Farivar, MD, PhD*

University of Iowa Hospitals and Clinics, Carver College of Medicine, Iowa City, Iowa

Received for publication October 28, 2009; accepted for publication November 6, 2009.

* Address for reprints: Robert Saeid Farivar, MD, PhD, University of Iowa Hospitals and Clinics, Carver College of Medicine, 200 Hawkins Dr, SE 517GH, Iowa City, IA 52242. (Email: robert-farivar@uiowa.edu).

The first 20% of the full text of this article appears below.


   Clinical Summary
 
A 68-year-old woman was admitted 44 years after undergoing mitral valve replacement with a Starr–Edwards (SE) prosthesis (Edwards Lifesciences, Irvine, Calif) for rheumatic mitral valve stenosis. Since implantation of the prosthesis in 1965 via thoracotomy, the patient had done well and maintained her anticoagulation with warfarin sodium (Coumadin). She now had fatigue and anemia. Of note, 2 years earlier the patient had had third-degree heart block necessitating the implantation of a dual-chamber pacemaker. A full workup including upper and lower endoscopy did not reveal a source of bleeding. Hematologic testing showed decreased haptoglobin, a high lactic dehydrogenase value, and increased reticulocyte count, consistent with a hemolytic anemia. Bone marrow biopsy was performed, which showed erythroid hyperplasia, normocellular bone marrow, normal megakaryocytes, and absent iron, indicative of iron deficiency anemia. Despite iron replacement . . . [Full Text of this Article]




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