XXXX and infective endocarditis in a mitral prosthetic valve.

@entity1 @entity417 @entity1353 @entity2104 @entity2478 @entity425 @entity338 @entity797 @entity880 @entity2142 @entity1851
Traumatic @entity2142 after heart valve replacement can be a serious problem. It is commonly associated with either structural @entity2478 . A 63-year-old @entity1 with a six-year history of surgery for mitral stenosis presented with complaints of @entity425 and @entity1353 . She received treatment at other centers three times in the past six months for @entity1353 and @entity417 requiring transfusion of red blood cells. Transthoracic echocardiography showed a normally functioning mitral mechanic prosthesis. Laboratory findings were abnormal for hemoglobin, hematocrit, white blood cell count, @entity1851 , serum @entity2104 , and @entity880 dehydrogenase. Peripheral blood smear showed marked schistocytes, indicative of mechanical erythrocyte destruction. Transesophageal echocardiography demonstrated severe @entity2478 and a large (9x13 mm) vegetation adhering to the prosthetic valve, protruding into the left atrium. @entity797 was isolated from blood cultures. Surgery was planned because of large vegetation, repeated @entity2142 , and severe @entity338 , but the @entity1 refused surgical treatment.
