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The longevity of mechanical mitral valves has enabled many patients to live normal lives for decades following replacement. This case illustrates the complex decision-making process when a long-functioning mechanical valve begins to fail, highlighting the importance of optimal timing for reintervention.
Mrs. Sarah Dinah, a 74-year-old woman, was diagnosed with rheumatic mitral disease in 1980. Due to progressive symptoms, her native valve was replaced with a mechanical valve in 1984, after which she maintained a normal life until 2022. Her condition then began to deteriorate progressively, with increasingly severe exertional dyspnea even with minimal effort. She developed chronic atrial fibrillation with subtherapeutic INR due to intestinal bleeding when her coumadin dose was increased. Despite oral and parenteral diuretics providing temporary relief, echocardiographic monitoring revealed preserved left ventricular function but gradually increasing pulmonary pressure.