What procedure was most recently performed on this patient?

Answer A. Mitral-valve repairThe peripheral-blood smear showed schistocytes, spherocytes, and polychromasia suggestive of hemolytic anemia. Following mitral-valve repair, some patterns of the regurgitant flow disturbances associated with high shear stress are responsible for the hemolysis. Transesophageal echocardiography in this patient showed a jet of mild transvalvular mitral regurgitation. The hemolysis resolved after mitral-valve replacement.