My wife had heart surg 6 years ago at age 21 for replacement of mitral valve(mechanical). she maintains proper inr. any clinical significance needed?

Unfortunately: Unfortunately without knowing the type of valve, and the full medical and medication history many of us here will be hesitant to make any comments. I would assume her cardiologist or heart surgeon has her on a strict program of diet and exercise and medications. They surely will also have her on a schedule for routine monitoring visits.