title: Freedom from complications related to dual ball-and-cage mechanical valve prostheses despite thirty years without anticoagulation.
abstract: We report a case of a 57-year-old patient with a history of a Starr-Edwards mitral valve prosthesis and DeBakey-Surgitool aortic valve prosthesis implanted 30 years ago who presented with symptoms consistent with class IV heart failure. The patient had been on no anticoagulation for approximately 30 years secondary to recurrent epistaxis occurring two years after starting warfarin therapy postoperatively. Throughout the patient's lifetime he experienced no thromboembolic complications from the lack of anticoagulation, despite developing concomitant atrial fibrillation approximately ten years prior to admission. In place of warfarin the patient had substituted large doses of aspirin. A workup revealed normal function of the mechanical valves for this extensive period.
authors.affiliation: Department of Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103, USA. mem2y@hotmail.com
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Miller
authors.forename: Robert
authors.initials: R
authors.lastname: Hipp
authors.forename: Martin E
authors.initials: ME
authors.lastname: Matsumura
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001021:Aortic Valve / Q000601:surgery*; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D004697:Endocarditis, Bacterial / Q000601:surgery*; D004844:Epistaxis / Q000139:chemically induced; D006333:Heart Failure / Q000150:complications; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011474:Prosthesis Design; D012651:Self Medication; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin