Key result
Mitral valve replacement with a mechanical prosthesis was chosen for a 76-year-old woman with rheumatic mitral stenosis and atrial fibrillation due to her need for chronic anticoagulation.
Case Report (n=1)
Highlights the clinical decision-making process for choosing a mechanical over a bioprosthetic mitral valve in an elderly patient who already requires chronic anticoagulation for atrial fibrillation.
Supports individualized mechanical valve selection when anticoagulation is mandated; case report leaves broader applicability open.
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.
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Ganeshpure et al. (2012) conducted a case report in Rheumatic heart disease with mitral stenosis (n=1). Mitral valve replacement with mechanical prosthesis was evaluated. Mitral valve replacement with a mechanical prosthesis was chosen for a 76-year-old woman with rheumatic mitral stenosis and atrial fibrillation due to her need for chronic anticoagulation.
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