title: Recurrent protein-losing enteropathy and tricuspid valve insufficiency in a transplanted heart: a causal relationship?
abstract: This case report describes a toddler who developed a protein-losing enteropathy (PLE) 4 years after orthotopic heart transplantation (OHT). He was born with a hypoplastic left heart syndrome for which he underwent a successful Norwood procedure, a Hemi-Fontan palliation, and a Fontan palliation at 18 months of age. Fifteen months following the Fontan operation, he developed a PLE and Fontan failure requiring OHT. Four years after OHT, he developed a severe tricuspid regurgitation and a PLE. His PLE improved after tricuspid valve replacement. It is now 2 years since his tricuspid valve replacement and he remains clinically free of ascites and peripheral edema with a normal serum albumin level. His prosthetic tricuspid valve is functioning normally.
authors.affiliation: Division of Pediatric Cardiology Department of Cardiovascular Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI 48201, USA. ssanjeev@dmc.org
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Delius
authors.forename: Henry L
authors.initials: HL
authors.lastname: Walters
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: L'Ecuyer
mesh_terms: D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D018729:Fontan Procedure / Q000009:adverse effects*; D016027:Heart Transplantation / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D008297:Male; D011504:Protein-Losing Enteropathies / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery