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Volume 5

Journal of Current Research: Cardiology

Heart Congress 2018

November 21-22, 2018

Page 17



Global Heart Congress

November 21-22, 2018 Osaka, Japan

Prosthetic mitral valve without anticoagulation for ten years: A case report


92 years old man visited the cardiology clinic with dyspnea on exertion of functional class III. On medical history he

had history of mitral valve replacement 10 years before at a tertiary center. He had been on Warfarin for 6 months after

surgery, but he did not continue follow up and discontinued taking Warfarin after that period as he was living in a far village

without possibility of checking INR (International Normalized Ratio) and adjusting his medication. On P/E there was the

metallic sound of prosthesis present and a soft systolic and diastolic murmur at the apex. As he was not on anticoagulation for

years he was admitted for anticoagulation and performing trans-thoracic echocardiography. On admission he had Hb level of

12 vg/dL with platelets of 100,000/ml and his INR was 1. On echocardiography, he had severe LV (Left Ventricular) systolic

dysfunction, thrombosed lateral leaflet of prosthetic valve with reduced mobility, a fixed clot in left atrium and pulmonary

artery pressure of around 35 mmHg. As he was admitted in a rural hospital, he was candidate of referral to tertiary center for

trans-esophageal echocardiography and evaluation for surgery. The patient refused to transfer and follow up; He was put on

intravenous anticoagulation for 5 days with Heparin and also Warfarin was started for him. He was discharged with an INR of

3 on Warfarin, Aspirin, Furosemide and Carvedilol and Losartan. He had good follow up for 2 months and his INR was within

2.7 and 3.2 and was symptom free. Unfortunately, he did not have follow up for 6 months and he was admitted with epistaxis

and high INR and Hb level of 6 g/dL. The valve condition remained the same and after blood transfusion and INR control he

was discharged symptom free. It has been 2 months that he has had good INR control and is symptom free.


Mohammad Mostafa Ansari-Ramandi has completed his post graduate medical studies in Cardiology at Iran University of Medical Sciences and

MD in Cardiology at Qazvin University of Medical Sciences, Iran. As a Cardiologist he has contributed much in research fields and his main field of

interest is heart failure and cardiovascular imaging. He is working as the Head of the CCU and PCCU wards of Syed Mostafa Khomeini Hospital in

Tabas, Iran.

Mohammad Mostafa Ansari-Ramandi

Birjand University of Medical Sciences, Iran

Mohammad Mostafa Ansari-Ramandi, Curr Res Cardiol 2018, Volume 5

DOI: 10.4172/2368-0512-C1-001