title: Late clinical manifestations of mitral valve disease and severe pulmonary hypertension in a patient diagnosed with premature closure of foramen ovale during fetal life.
abstract: BACKGROUND
  The patency of foramen ovale (FO) in fetal circulation is very important, and premature closure of FO could be associated with several pathological conditions.
  
  
  METHODS
  We report a patient in whom premature closure of FO in fetal life was associated with late clinical onset of mitral valve stenosis and subsequent development of irreversible pulmonary hypertension (PH).
  
  
  RESULTS
  The patient showed persistent PH after birth, which completely regressed at the age of 8 months. However, the patient developed heart failure due to mitral valve lesions (hammock valve) at the age of 11 months and underwent artificial valve replacement. The patient subsequently developed severe PH, which was refractory to anti-PH therapy with sildenafil and bosentan in addition to home oxygen.
  
  
  CONCLUSIONS
  This case illustrates that mitral stenosis can be overlooked during early neonatal life, and thus emphasizes the need for close follow-up for potential existence of mitral stenosis and later clinical manifestation in patients with premature FO closure even when initial careful examination of the mitral valves does not indicate any abnormalities. In addition, premature closure of FO could cause pulmonary vascular disease, which may lead to later development of irreversible PH.
authors.affiliation: Department of Pediatric Cardiology and Pediatrics, Saitama Medical University, Saitama, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Iwamoto
authors.forename: Akiko
authors.initials: A
authors.lastname: Tamai
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Mio
authors.initials: M
authors.lastname: Taketazu
authors.forename: Hideaki
authors.initials: H
authors.lastname: Senzaki
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D000077300:Bosentan; D006328:Cardiac Catheterization; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D054085:Foramen Ovale / Q000002:abnormalities*; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology*; D007231:Infant, Newborn; D008297:Male; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000627:therapeutic use; D013450:Sulfones / Q000627:therapeutic use; D017211:Treatment Failure; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D010879:Piperazines; D011687:Purines; D013449:Sulfonamides; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D000077300:Bosentan