Letters to the Editor: Thirty-six years with the same prosthetic mitral valve

A 62-years-old female patient presented to our clinic with right heart failure. On her past medical history there was a history mitral valve surgery 36 years ago, which was performed for replacement of stenotic rheumatic mitral valve with Starr-Edwards cage-balled prosthetic valve. She was doing well except a history of transient ischemic attack nearly 30 years ago. Recently she developed clinical signs of right heart failure. On echocardiogram there was an excellent working prosthetic mitral valve, with gradients of 12/6 mmHg (maximum/mean) and no mitral regurgitation (Fig. 1). However, it was seen that she had severe tricuspid stenosis with gradients of 15/7 mmHg (maximum/mean) and also severe tricuspid regurgitation. After compensation of patient, coronary angiography and ventriculography was performed and patient was scheduled for tricuspid valve surgery (Fig. 2, 3).