Mechanical mitral valve thrombosis in rheumatic valve disease.

A lady in her late 30s was admitted with a 2-week history of shortness of breath and productive cough. She had been treated for presumed lower respiratory tract infection but had not clinically improved. Her medical history includes rheumatic fever in childhood and she had undergone bioprosthetic mitral replacement (Carpentier-Edwards) 15 years ago. She had redo-surgery with mitral (25 mm carbomedics) and aortic (21 mm carbomedics) replacement and tricuspid repair 6 years ago. She was on long-term treatment with phenindione (allergy to warfarin) but due to supply problems had been switched to sinthrone recently. Her anticoagulation record confirmed subtherapeutic International Normalised Ratios for the past 2–3 months. The patient underwent a transthoracic echocardiogram which revealed an increased gradient across the mitral valve suggestive …