title: A man with dark urine and shortness of breath: a case-based review of paravalvular leaks.
abstract: A 62-year-old man presented to his general practitioner with a 10-day history of dark red urine. Subsequent blood tests revealed an acute kidney injury and anaemia. His only medical history was a prosthetic mitral valve replacement 30 years previously for rheumatic valve disease. Following referral to a urology service, initial investigations, including CT KUB (kidneys, ureters, bladder), excluded a urological cause for his presentation. A haemolysis screen was positive. A transthoracic echocardiogram reported severe aortic stenosis and aortic incompetence. A transoesophageal echocardiogram revealed a paravalvular leak at the prosthetic mitral valve. The patient was referred to a regional cardiothoracic centre, and underwent a repeat mitral valve replacement and an aortic valve replacement.
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: James P
authors.initials: JP
authors.lastname: Curtain
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: James William
authors.initials: JW
authors.lastname: O'Brien
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology; D000743:Anemia, Hemolytic / Q000175:diagnosis* / Q000209:etiology; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000209:etiology; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications / Q000601:surgery; D011475:Prosthesis Failure / Q000009:adverse effects*; D012214:Rheumatic Heart Disease / Q000601:surgery; D016482:Urinalysis