It is not unusual to find a Doppler derived peak gradient of 40 mm Hg across a Bjork-Shiley valve in the aortic position. However, in the case reported below1 further investigation led to the identification of thrombus, and the patient underwent reoperation despite being asymptomatic. Should this case affect our management of mechanical valves?

Most centres perform routine postoperative echocardiography. This is useful to compare with future studies as a new paraprosthetic leak may be a sign of endocarditis, and a major change in forward …