title: Complicated rheumatic mitral stenosis presenting in an elderly patient and the challenges in its management.
abstract: A 76 -year-old lady with a recent diagnosis of rheumatic heart disease (RHD), and a history of repeated lower respiratory tract infections, came with symptoms of gastritis unrelated to the primary disease but further diagnostic study in the hospital revealed poorly controlled atrial fibrillation, grossly dilated left atrium with two large left atrial thrombi and mitral valve area<1 cm(2). It was decided that the best approach in our patient would be mitral valve replacement with mechanical prosthesis. Despite the usual trend of using bioprosthesis in the elderly, our decision was influenced by the fact that the patient would need chronic anticoagulation for atrial fibrillation in any case. The purpose of our case presentation is to illustrate a late-presenting case of RHD with unusual associations and the challenges to choose the best possible management.
authors.affiliation: Department of Medicine,  Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra,  India.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Ganeshpure
authors.forename: Gaurang Nandkishor
authors.initials: GN
authors.lastname: Vaidya
authors.forename: Vipul
authors.initials: V
authors.lastname: Gattani
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D006332:Cardiomegaly / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D005756:Gastritis / Q000150:complications; D006331:Heart Diseases / Q000150:complications; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D012213:Rheumatic Fever / Q000150:complications; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D014859:Warfarin