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Shaikhrezai et al. Late presenting valve endocarditis

the valve orifice is uncommon. Pannus formation was may have a role in the mechanical valves of the future
the causes mechanical valve obstruction in about 10% despite the findings of the recently published RE-
of valves. [3] ALIGN trial. [10] It may be a reality to have alternatives
to coumadin therapy for mechanical valves in the near
Implantation of prosthetic valve in tricuspid position future.
has been debated frequently in the literature with a
consensus on bioprosthesis favouring mechanical DECLARATIONS
valve due to the increased occurrence of valve-related
events, especially the composite of thrombosis, Authors’ contributions
embolism, and bleeding high risk of thrombosis when Writing manuscript, operating surgeon: K. Shaikhrezai
a mechanical valve is implanted in tricuspid position. [4,5] Writing and reviewing manuscript: S.S.A. Singh
The management of thrombosis can be challenging and
depending on patient clinical manifestation or degree Reviewing manuscript: C. Spadaccio
Supervision and operating surgeon: S. Hunter
of valvular obstruction the management can vary from
observation to emergency operation. [6]
Financial support and sponsorship
With the emergence of transcatheter technology, None.
bioprosthetic valve implantation in the tricuspid position
is an ideal alternative while future valve-in-valve Conflicts of interest
implantation feasible in the event of valve failure. There are no conflicts of interest.
[7]
To our knowledge there is no report of mechanical
valve implantation lasting more than 30 years in the Patient consent
tricuspid position. The abovementioned patient had Written consent was obtained from the patient
excellent compliance with anticoagulation therapy, preoperatively.
thus explaining his mechanical valve longevity without
any episodes of thrombosis. It has been observed that Ethics approval
non-compliance with coumadin plays a pivotal role in Medical Photography was obtained with permission
thrombosis and valve malfunction. [4] from the patient and the Local Clinical Governance
Committee.
Bjork-Shiley tilting disc valves had a good clinical
profile following decades of implantation. However, REFERENCES
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