Mechanical Aortic Valve Without Anticoagulation For Twenty-S
Mechanical valvular prostheses have the advantage of longevity but carry a risk of thrombosis, which is dependent from valve design, materials and host-related interface. These prostheses composed of metal or carbon alloys have the advantage of long-term durability, but they carry an increased risk of thrombo-embolism as well as definite risk of bleeding secondary to anticoagulation (1).
Anticoagulation is known as essential for mechanical heart valves to prevent lethal complications such as valve thrombosis and systemic embolism. Current guidelines necessitate varying degrees of long-term anticoagulation in patients with mechanical heart valve(s) to prevent thrombotic and embolic complications.
We report the case of a patient has a Bjork-Shiley tilting disc mechanic valve in the aortic position without anticoagulation during 26 years event free and now presented with valve disfunction.

Case Report
A 47-year-old man had an aortic valve replacement in 1985-a Björk Shiley mechanical heart valve had been implanted. His native valve was incompetent from infective endocarditis. After surgery, he did not have any problems. He discontinued warfarin a few months after the surgery and presented 26 years later with palpitations and dyspnea on exertion for one month. On auscultation, mechanical valve sounds were absent.Transoesophageal echocardiography showed thrombotic material adjacent to the prosthesis. A cross sectional view through the aortic root revealed thrombi (Figure 1A) localized at the prosthetic ring protruding into the lumen. A long axis view of the ascending aorta showed flow exclusively across the major orifice by color Doppler.
The patient was then taken to surgery....