Abstract
Despite revolutionary changes in the field of medicine and eradication or prevention of many diseases worldwide in the past few decades, rheumatic heart disease (RHD) still remains as one of the largest preventable disease burdens in the world and is seen to be more prevalent in the developing countries1 . Majority of RHD patients develop valvular heart disease with mitral valve incompetence as the most common valvular lesion seen in these patients2 . In symptomatic patients or those in whom evidence of impaired LV function at rest is seen, surgical intervention is the definitive treatment 3 . Patients who undergo surgical intervention may have either a bio prosthetic valve replacement or a mechanical valve replacement. Those in the latter group requires to be initiated on vitamin K receptor antagonist drugs like warfarin in order to prevent thrombus formation of the mechanical valves.