Spontaneous Partial Remission of Postoperative Hemolytic Anemia in a Case with Ostium Primum Defect

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Abstract
Hemolytic anemia, after repair with a Teflon patch of an ostium primum defect with a cleft in mitral valve, was observed in a patient. An extensive search failed to demonstrate any cause of the hemolytic anemia which was, therefore, considered to be mechanical in origin secondary to regurgitation of blood through the residual cleft in the mitral valve against the Teflon patch. A concurrent iron deficiency anemia was noted. The patient was noted to be losing iron in the urine. With increasing anemia, congestive heart failure developed. It is postulated that the concurrent iron deficiency anemia by further aggravating the chronic hemolytic anemia led to high output cardiac failure, progressive cardiac dilatation, increased mitral regurgitation and greater impact of a high velocity regurgitant-jet against the Teflon patch resulting in more hemolysis. Correction of the anemia by blood transfusions and maintenance of hemoglobin and hematocrit at normal level by oral iron therapy broke the vicious cycle. In view of the high mortality associated with re-operation, intensive medical management to maintain hemoglobin and hematocrit at normal level would appear to be an important factor in management of such cases.