Hemolytic anemia 19 years after mitral valve replacement with a porcine bioprosthesis

A 58-year-old man required replacement of a porcine mitral prosthesis because of severe hemolysis 19 years after implant. At operation the major pathologic finding was a perforation of one cusp with calcific deposition limited to the commissures. Clinically evident hemolytic anemia due to porcine valve dysfunction is rare particularly occurring very late postoperatively due to cusp perforation as in the present case