Abstract
A 72-year-old female patient underwent aortic valve replacement (SJM Regent, 19-mm) for aortic stenosis in June 2011. Warfarin dosing was poorly controlled at another hospital. In July 2014, the patient was brought to our hospital by ambulance because of complaints of general fatigue and tarry stool. She was diagnosed with a hemorrhagic gastric ulcer and underwent endoscopic hemostasis. On Day 2 of hospitalization, an increased valve pressure gradient was observed by echocardiography, and valve fluoroscopy revealed that one of the leaflets remained fixed in a half-closed position. Thus, we diagnosed an artificial valve malfunction. However we did not observe heart failure, and determined that emergency surgery was unnecessary. After confirming hemostasis of the hemorrhagic gastric ulcer, we continued anticoagulant therapy with heparin and warfarin. The patient showed some improvement in the mobility of the artificial valve leaflets under fluoroscopy on Day 45, and was discharged on Day 59 with warfarin alone. The mobility of the artificial valve leaflets returned to normal with strict outpatient anticoagulant management. This case was significant for successful treatment using anticoagulant therapy alone, thus avoiding both surgery for valve thrombosis and thrombolytic therapy.
