Yanal F. Al-Naser
Queen Alia Heart Institute, Jordan
Title: 35 years off warfarin-Standing the “Test “or “Challenge†of time?
Biography
Biography: Yanal F. Al-Naser
Abstract
A 46 year old female patient, with no medical illnesses was referred to my clinic with effort intolerance and palpitations of four years duration. Her history dates back to when she was 11 when she had an Aortic and Mitral valve replacement due to rheumatic causes, she had a size 19mm bileaflet mechanical aortic valve and a size 27mm bileaflet mechanical mitral valve. She was started on warfarin and took it for three months of her life as documented by her family members and follow up notes till she decided to stop it. She stated that she took no medications at all and was completely asymptomatic, she got married and had three children, all a normal vaginal delivery aided by a mid wife at home. Her 2DECHO showed a grade three para-leaking aortic and mitral valves, and was referred to me for a redo AVR and MVR 35 years later, being off warfarin for all that period and was asymptomatic for 30 years and never had a stuck valve. Her coagulation profile was normal, with an INR of 1, I operated on her and found a rim of pannus surrounding the valves, but the leaflets were mobile. I replaced both valves using St Jude size 21 Aortic Valve and size 29 Mitral valves, both mechanical. There are a few cases described in literature about mechanical valves with no warfarin, but I believe this is one of those with the longest –off warfarin- history.