Paravalvular leaks and hemolytic anemia following insertion of Starr-Edwards aortic and mitral valves

Summary Paravalvular leaks were encountered in 27 of 203 patients (13 per cent) following aortic valve replacement and in 10 of 108 patients (9 per cent) after prosthetic mitral valve replacement. The diagnosis of paravalvular leaks and assessment of their significance was difficult and required a comprehensive survey of clinical, radiographic, hemodynamic, and angiographic studies. Hemolytic anemia developed in 11 patients in the aortic group, occurring most often in patients operated upon initially for calcific aortic stenosis. Congestive heart failure was not a significant problem except in 6 cases of persistent hemolytic anemia in which reoperation was necessary. In 4 patients, anemia regressed spontaneously. Sixteen of the 27 patients did not require second operations. Twenty of the 27 patients in this group are alive and well at the present time. Refractory congestive heart failure occurred in 9 of the 10 patients with mitral leaks. One patient died suddenly. Significant hemolysis was attributed to the mitral leak in 1 and, possibly, 2 cases. Reoperation was carried out in 7 patients, 4 of whom are living at present. Five patients with paravalvular regurgitation, secondary to a circumferentially torn mitral annulus, had ruptured chordae tendineae at their initial operation which raises the possibility that the chordae, annuli, and valves in such patients may have a defect in the matrix or ground substance which predisposes to the development of leaks.