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A 28-year-old man with idiopathic dilated cardiomyopathy who had had St. Jude aortic- and mitral-valve replacements 3 years earlier presented with decompensated heart failure. The examination was notable for marked jugular venous distention, an S3 gallop, and a palpable left ventricular heave. The carotid upstrokes were normal, but the prosthetic second heart sound was diminished. A grade 2/6 systolic murmur was audible at the right upper sternal border. The international normalized ratio was 3.0 and had been within the therapeutic range consistently over the previous months. Valve fluoroscopy confirmed immobilization of one of the mechanical aortic-valve leaflets, consistent with obstruction . . . [Full Text of this Article] |
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