A 46-year-old man came to the outpatinet clinic for a routine follow-up examination. He has no symptoms at this time. Three months ago, he underwent aortic valve replacement with a mechanical prosthesis. His hematocrit at discharge was 35%. On physical examination, vital signs are normal. He has a normal S1 and mechanical S2 without an S3 or S4. Other physical examination findings are normal.

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