Emergency correction of coagulation for mitral valve replacement in an orally anticoagulated 17-year-old patient with pronounced hepatic dysfunction

A 17-year-old patient with Shone's disease had to be readmitted to the hosp ital 3 months after implantation of an artificial aortic valve because of e xtreme mitral insufficiency with consecutive pulmonary edema and hepatic dy sfunction. He had been orally anticoagulated and presented with a high inte rnational normalized ratio of 6.7. Emergency replacement of the mitral valv e was possible only after administration of prothrombin-complex concentrate , as vitamin K-1 and fresh frozen plasma did not correct the hemostatic def ect sufficiently.