title: Obstructive prosthetic atrioventricular valve thrombosis in a woman with congenitally corrected transposition of the great arteries during estrogen replacement therapy for pituitary dysfunction.
abstract: A 27-year-old woman was admitted because of breathlessness, orthopnea, and hemoptysis. The present patient was diagnosed with congenitally corrected transposition of the great arteries (cc-TGA) and underwent systemic atrioventricular valve replacement for severe insufficiency at 23 years of age. She also had been treated with oral conjugated equine estrogen (Premarin) because of congenital pituitary dysfunction. Despite appropriate anticoagulation therapy with warfarin, echocardiography and fluoroscopy showed stuck leaflets of the prosthetic valve due to thrombosis. She underwent emergent surgical valve replacement. This rare association suggests that oral hormone replacement therapy poses a risk of thrombosis especially in patients with cc-TGA after prosthetic valve replacement.
authors.affiliation: Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. mune@pediatr.med.kyushu-u.ac.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Muneuchi
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Yamamura
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakashima
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ushijima
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D004966:Estrogens, Conjugated (USP) / Q000009:adverse effects*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D010900:Pituitary Diseases / Q000151:congenital / Q000188:drug therapy*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D012720:Severity of Illness Index; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014188:Transposition of Great Vessels / Q000150:complications*; D017211:Treatment Failure; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D004966:Estrogens, Conjugated (USP); D014859:Warfarin