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A 63-year-old woman presented for evaluation after 2 weeks of progressive dyspnea. She had a history of dilated cardiomyopathy, and a St. Jude prosthetic valve had been inserted in the mitral position 6 years earlier for mitral insufficiency. Since then she had been taking a maintenance dose of warfarin. The physical examination was notable for bibasilar crackles and a muffled S1 heart sound. The international normalized ratio was subtherapeutic at 2.0 (target range, 2.5 to 3.5). Fluoroscopy of the prosthetic mitral valve showed that one of the leaflets was stuck in the closed position (Video 1). Transesophageal echocardiography . . . [Full Text of this Article] |
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