Medical optimization of anticoagulation and heart failure management resulted in complete resolution of the frozen prosthetic valve leaflet and normalization of pressure gradients across the mitral prosthesis, eliminating the need for repeat surgery.

48-year-old female with Ehlers-Danlos syndrome, severe mitral insufficiency treated with mitral valve replacement with a bi-leaflet mechanical prosthesis 10 years prior, chronic interstitial lung disease, and severe autonomic dysfunction with permanent pacemaker, presenting with mechanical mitral valve thrombosis and heart failure exacerbation in the setting of subtherapeutic anticoagulation (INR 1.0). n=1.

Intravenous furosemide and intravenous heparin bridged to warfarin, followed by maintenance on oral warfarin and diuretics.

Resolution of mechanical prosthetic valve thrombosis and normalization of valve function.