What is the clinical evidence from this study?

Study design: Case Report. Population: Severe mitral regurgitation with post-TMVI hemolysis and paravalvular leakage (n=1). Intervention: Valve re-tensioning. Primary outcome: Resolution of hemolysis and paravalvular leakage.

What question did this study set out to answer?

To evaluate the management of severe hemolysis following transcatheter mitral valve implantation (TMVI).

June 24, 2026Open Access

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

SWS K WangUniversity of Science and Technology of China QSQian-Hui SunKunming Medical University ZRZi-Ming RaoKunming Medical University

Key Result

Valve re-tensioning successfully resolved severe paravalvular leakage and hemolytic anemia caused by late valve dislodgement following transcatheter mitral valve implantation.

Key Points

To evaluate the management of severe hemolysis following transcatheter mitral valve implantation (TMVI).
Performed TMVI in a 75-year-old female with severe mitral regurgitation
Conducted valve re-tensioning via prior thoracotomy after rehospitalization
Used transesophageal echocardiography for accurate diagnosis
Successful valve re-tensioning resolved paravalvular leakage (PVL)
Severe hemolysis symptoms were alleviated after intervention
No further complications reported post procedure

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does valve re-tensioning resolve hemolysis and paravalvular leakage in patients with late valve dislodgement after transcatheter mitral valve implantation?

Population

A 75-year-old frail female with severe mitral regurgitation who developed severe paravalvular leakage and hemolysis due to late valve dislodgement after transcatheter mitral valve implantation.

Intervention

Valve re-tensioning via prior thoracotomy

Outcome

Resolution of paravalvular leakage and relief of hemolysis

Valve re-tensioning via prior thoracotomy can successfully manage severe paravalvular leakage and hemolysis caused by late valve dislodgement after transcatheter mitral valve implantation.

Limitations

Inherent limitations of single-case reports

Abstract

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.

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