title: [Discrete type subaortic stenosis disclosed by hemolytic anemia after aortic and mitral valve replacement].
abstract: We report a case of discrete type subaortic stenosis disclosed by hemolytic anemia 7 years after aortic and mitral prosthetic valve replacement. A 53-year-old female complained of general fatigue, dyspnea, macrohematuria and hemolysis. She had undergone aortic valve replacement for non-coronary cusp perforation 15 years before, and mitral valve replacement and tricuspid annuloplasty 7 years before. Echocardiography showed mitral prosthetic valve regurgitation (III/IV degree) and symptomatic hemolysis might be caused by accelerated blood flow through the prosthetic valve. A mild aortic stenosis (peak flow verocity:3.73 m/s) was also pointed out. The redo double valve replacement was performed. Intraoperative findings showed discrete type subaortic stenosis due to extensive pannus formation, but that the previously implanted prosthetic valves were intact. The blood flow biased by the interference of the subaortic stenosis might have obstructed closure of the mitral prosthetic valve and caused mitral regurgitation. Postoperatively, hemolysis and mitral regurgitation were diminished, and aortic stenosis was improved.
authors.affiliation: Department of Cardiovascular Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kawahara
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Inage
authors.forename: Naoki
authors.initials: N
authors.lastname: Masaki
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Ryota
authors.initials: R
authors.lastname: Jinbu
authors.forename: Shuji
authors.initials: S
authors.lastname: Toyama
authors.forename: Manabu
authors.initials: M
authors.lastname: Fukasawa
mesh_terms: D000743:Anemia, Hemolytic / Q000209:etiology*; D001021:Aortic Valve / Q000601:surgery*; D021922:Discrete Subaortic Stenosis / Q000150:complications*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology; D011183:Postoperative Complications