CLINICAL HEMOLYSIS WITH THE ST-JUDE HEART-VALVE WITHOUT PARAVALVULAR LEAK

In 1990 and 1991 we operated on 2 patients with persistent clinical he molysis, in the absence of perivalvular: leaks, who had had their mitr al valves replaced with St. Jude Medical valve (SJMV) prostheses. The valves had been implanted 14 months and 3 months before, respectively. There were no other discernible causes for the hemolysis and when eac h SJMV was replaced the hemolysis disappeared in that patient. The fir st valve was not tested in the laboratory owing to its loss, but it lo oked normal. The second valve was tested and found to have regurgitati on well within the usual limits for this valve. Fringe pattern interfe rometry indicated that the leading edge of each leaflet was flatter an d less smooth than that of another SJMV. Reviewing the literature we f ind that idiopathic, persistent clinical hemolysis in recipients of St . Jude mechanical heart valves is a rare phenomenon, which has appeare d in 4 reports totaling 9 cases. We discuss the suggested mechanisms i nvolved, and add the possibility of leading leaflet edge characteristi cs.