High-output states like severe anemia from valve-related hemolysis can cause spuriously elevated transvalvular gradients masquerading as prosthetic valve stenosis, which resolves with treatment of the anemia.
High-output states warrant exclusion before diagnosing prosthetic stenosis; case report leaves open need for validated algorithms.
The evaluation of prosthetic valves can provide a unique challenge, and a thoughtful approach is required. High output states like anemia should be kept in the differential when evaluating elevated gradients across prosthetic valves. We present the case of a 69-year-old man with a Starr-Edwards prosthetic aortic valve who presented with symptoms of congestive heart failure and high transvalvular pressure gradients. These symptoms indicate a potential prosthetic valve stenosis. His laboratory evaluation results were consistent with valve-related hemolysis. Resolving his anemia led to a resolution of the symptoms and lowered the pressure gradient on follow-up.
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Pooja et al. (2017) studied this question.
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