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Asian Cardiovasc Thorac Ann 2005;13:396-397
© 2005 Asia Publishing EXchange Ltd

IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Cause or Consequence: Pannus Formation on Tissue Aortic Valve with Extended Life

Hazem B Fallouh, MRCS, Ian Hunt, MRCS, John Chambers, FRCP, Fikrat P Shabbo, FRCS

St. Thomas’ Hospital, London, United Kingdom

For reprint information contact: Hazem B Fallouh, MRCS Tel: 44 779 534 4141 Fax: 44 207 188 3902 Email: hazem.fallouh{at}kcl.ac.uk, Cardiac Surgical Research, The Rayne Institute, St. Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom.

A 79-year-old woman became progressively breathless 21 years after implantation of a standard Carpentier-Edwards stented porcine tissue aortic valve. She had been maintained on low-dose aspirin (75mg daily) since surgery. Echocardiography revealed severe left ventricular outflow obstruction (effective orifice area 0.5 cm2 by the continuity equation) with obstructive pannus on the ventricular surface (Figure 1Go). At redo surgery, the presence of pannus was confirmed. The cusps of the prosthesis were thin and mobile (Figure 2Go and 3Go).



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  		Figure 1. Transthoracic echocardiogram, parasternal long axis view, showing the pannus (Arrow), valve stent (S), mitral valve (MV), aorta (Ao), left ventricle (LV), left atrium (LA).

 


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  		Figure 2. Aortic prosthesis, ventricular surface, with cusps open.

 


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  		Figure 3. Aortic prosthesis, ventricular surface, with cusps closed.

 
Pannus is not unusual in mechanical valves, but is rarely reported in biological valves1. This case suggests that pannus may become more common with the longer durability now expected from modern biological valves2. Whether pannus in this case could have reduced stresses on the cusps so protecting them from the usual processes of ‘wear and tear’ must remain purely speculative.

REFERENCES

  1. Grunkemeier GL, Li HH, Naftel DC, Starr A, Rahimtoola SH. Long-term performance of heart valve prostheses. Curr Prob Card 2000;25:73–156

  2. Pupello DF, Bessone LN, Lopez E, Brock JC, Alkire MJ, Izzo EG et al. Long-term results of the bio-prosthesis in elderly patients: impact on quality of life. Ann Thorac Surg 2001;71:244–8





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