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Patients with metallic prosthetic heart valves have to use anticoagulants throughout their life because of avoiding prosthetic valve thrombosis. We report the case of a patient with a prosthetic aortic valve without any event to date despite not using warfarin for 31 years. A 53-year-old man who underwent aortic valve replacement (AVR) with a mechanical valve (Medtronic,Inc., Minneapolis, Minesota) due to aortic valve disease 31 years ago was admitted to the cardiology department with complaints of chest pain and tiredness. In the examinations and anamneses, it was determined that the patient was followed up with acetylsalicylic acid and dipyridamole treatment without the administration of warfarin after the valve replacement. He underwent AVR in 1985 because of severe aortic stenosis. He was recommended warfarin, but he had no anticoagulation since then. His blood pressure was 125/85 mm Hg; his heart rate was regular at 90 beats/min. The baseline international normalized ratio was 1.1. The findings of his liver, thyroid, and kidney function tests were normal. His medications at home included acetylsalicylic acid 300 mg once a day and dipyridamole 50 mg QD. Transthoracic and transesophageal echocardiography revealed a non-functional metallic aortic valve with a gradient of 60/80 mm Hg. Fluoroscopy showed minimal motion of the aortic valve prosthesis. The patient primarily underwent the operation. Cardiac arrest after cross-clamp was observed in the patient who entered Anatol J Cardiol 2017; 17: 493-6 Letters to the Editor

A 31-year-old patient without the use of warfarin and with an aortic mechanical valve