My stepdaughter had mitral valve replacement surgery almost 3 years ago when she was 14 years old. She opted to have a tissue valve (pig aorta) instead of the mechanical valve because it was easier for her to adjust to in her lifestyle and because she wouldn't have to be placed on blood thinner medication for the duration of her life. Around about mid february of this year, she went to a gynecologist to acquire something for birth control, and after discussing her past medical history at length was prescribed the ortho evra patch. After reading the insert in the package, I could not understand why this form of birth control would be prescribed for her as it specifically warns that patients who have had disease of heart valves with complications should not use the patch and that it has been known to cause blood clots, heart attacks, and strokes. Unfortunately, we went under the assumption that the gynecologists knew what she was doing and since we don't have the benefit of her expertise and knowledge, we trusted that it would be safe. They say hindsight is 20/20, and I wish now I had gone with my initial instinct and had my stepdaughter see someone else. We could not ignore the fact that she was sexually active, and prompted her to get protection from a doctor, which she did. Three weeks later, she underwent surgery to have the valve replaced again as it had developed a blood clot on the valve which was blocking blood flow in her heart. I called the ortho mcneil medical information line to get more information, but as there have been no clinical studies done on patients who have had this type of surgery and their usage of this product, there was no information they could provide other than what was initially given in the information packet provided with the product. If anyone reading this can provide any information regarding the safety of this product in patients who have had mitral valve replacement and using this form of birth control, please respond. We have not gotten the test results back on the test being performed on the valve yet, so we're still not sure if the patch was the cause of the clot, although the cardiologist feels strongly that this is the culprit, as there have been no other changes in her lifestyle recently. She now has a mechanical valve and most likely will be released from the hospital today. We thank god that she has a wonderful surgeon that attacked this problem agressively and didn't try to cut corners, as he initially thought the valve was calcifying. He didn''t know there was a clot until the surgery. If she had been given blood thinner or even aspirin it could have released the clot and she could have had a stroke. We shudder to think of what could have happened. Anyone who has any information at all, please, please respond. Thanks.