Successful management of hemolysis after transcatheter mitral valve implantation by valve re-tensioning.

BACKGROUND

Transcatheter mitral valve implantation (TMVI) device featuring an apical fixation design is now the most mature TMVI system and widely applied in routine clinical practice. Nevertheless, severe unique complications including left ventricular outflow tract (LVOT) obstruction, paravalvular leakage (PVL), and hemolysis can still occur with this device. A 75-year-old frail elderly female with severe mitral regurgitation (MR) and recurrent heart failure was admitted to our institution for treatment. TMVI was successfully completed. The patient was subsequently rehospitalized owing to decompensated heart failure, PVL and severe hemolysis due to late valve dislodgement. We then performed valve re-tensioning via the prior thoracotomy, which resolved PVL and relieved hemolysis.

DISCUSSION: Subacute dislodgement of the prosthesis can still occur following TMVI with apical fixation design, leading to severe PVL and hemolysis. Accurate diagnosis using transesophageal echocardiography (TEE) combined with prompt re-tensioning is critical for the management of this complication.