![]() ![]() ![]() ![]() Laboratory investigations were normal except low INR, hematocrit, and hemoglobin level (9 gm/L due to iron deficiency anemia). Physical examination showed normal metallic first heart sound and weak metallic second heart sound. A 43-year-old female with a history of aortic valve (AV) and mitral valve replacement (bi-leaflet metallic valves), and tricuspid valve repair (MINI band) at October 2017. ![]()
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