title: Mechanical aortic valve without anticoagulation for twenty-three years.
abstract: Current guidelines necessitate varying degrees of long-term anticoagulation in patients with mechanical heart valve(s) to prevent thrombotic and embolic complications. We describe a patient with a functioning aortic mechanical valve without anticoagulation for 23 years. A 68-year-old man had an aortic valve (St Jude Medical) replacement in 1984. His native valve was incompetent from infective endocarditis. He discontinued Coumadin three months after the surgery. He presented 23 years later with palpitations for one month. Further work-up revealed a NYHA class I function, normal sinus rhythm, normal sized heart on chest X-ray, normal systolic and diastolic function on echocardiography. Mean transaortic gradient was 19 mmHg and calculated valve area was 1.48 cm(2). Fluoroscopy showed normal excursions of the mechanical aortic valve. Exercise stress test did not show any limitation in effort tolerance or perfusion defects. He was discharged on daily aspirin and clopidogrel.
authors.affiliation: Department of Cardiology, Jersey City Medical Center, Jersey City, NJ 07302, USA.
authors.forename: Shikha
authors.initials: S
authors.lastname: Sharma
authors.forename: Kirk
authors.initials: K
authors.lastname: McMurty
authors.forename: Narisety
authors.initials: N
authors.lastname: Chalapathy
authors.forename: Abdul
authors.initials: A
authors.lastname: Ameen
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001021:Aortic Valve / Q000382:microbiology / Q000601:surgery*; D004334:Drug Administration Schedule; D004696:Endocarditis / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D006349:Heart Valve Diseases / Q000382:microbiology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors