Asymptomatic Prosthetic Valve Dysfunction: Pannus?

Tayama, Eiki; Aoyagi, Shigeaki

doi:10.1046/j.1525-1594.2002.00909.x

Cited by 5 publications

(8 citation statements)

References 5 publications

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“…Small valve size (B19 mm), a specific valve type (Carbomedics), an etiology of rheumatic valve disease, and young age at the time of AVR (\48.8 years) were found to be independent predictors of moderate to severe pannus. The incidence of prosthetic valve obstruction due to pannus has been known to be uncommon (0.1-4.5 % per patient-year in the aortic position) [3,12,16], but recent studies have found that prosthetic aortic valve obstruction caused by pannus is more frequent than previously reported and can be detected even in asymptomatic patients [17,18]. In our study, pannus formation was present in most cases (77.2 %), even in cases which showed a normal range of PG on TTE (71.4 %).…”

Section: Discussionmentioning

confidence: 99%

Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve

Suh

Kim

Lee

et al. 2015

Int J Cardiovasc Imaging

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The clinical significance of pannus detected on computed tomography (CT) has not yet been investigated. The purposes of this study were to investigate the clinical significance of pannus detected on cardiac CT in patients who underwent aortic valve replacement (AVR) with mechanical valves, and to determine predictors for pannus severity. A total of 92 patients who underwent cardiac CT and TTE and who had undergone mechanical AVR were included. The geometric orifice area (GOA), the presence of limitation of motion (LOM) and pannus were evaluated on CT. The GOA, presence of LOM, and presence and severity of pannus were compared with echocardiographic parameters. Logistic regression analysis was performed to determine the predictors for pannus severity. The GOA on CT positively correlated with effective orifice area on TTE (r = 0.733, P < 0.0001). Pannus was found in 77.2% and LOM in 14.0%. With increasing pannus severity, mean transvalvular pressure gradient (PG) was significantly higher (P < 0.0001). Patients with elevated PG showed a smaller GOA, a higher incidence of pannus, more severe pannus and LOM than patients with normal PG (P < 0.05). Small valve size (≤19 mm), Carbomedics valve, rheumatic etiology, and young age at AVR (<48.8 years) were independent predictors of moderate to severe pannus (P < 0.05). Cardiac CT is helpful in the evaluation of pannus formation in patients with mechanical aortic valves. Moderate to severe pannus formation frequently occurred in patients with small mechanical valve size, Carbomedics valves, rheumatic heart disease and young age at AVR.

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Section: Discussionmentioning

confidence: 99%

Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve

Suh

Kim

Lee

et al. 2015

Int J Cardiovasc Imaging

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“…Transvalvular peak pressure gradient (mm Hg) and effective orifice area (cm 2 ) were measured by Doppler echo. Then, open angle cineradiography (Integris BH 5000, Philips Medical Systems, Eindhoven, The Netherlands) was examined in order to assess the patients' valve function (12,13).…”

Section: Methodsmentioning

confidence: 99%

“…We diagnosed 35 patients (18.7%) with PVD with deterioration of the prosthetic valve function measured by Doppler echocardiography, and obstruction of the open angle (normal: 11.0 ± 1.4 degrees) by cineradiography was calculated as the distance between the two leaflets in the fully open position greater than 20 degrees (12,13,16). Thirty patients who ranged from 15 to 19 degrees in cineradiography were excluded.…”

Section: Methodsmentioning

confidence: 99%

“… Obstruction of the aortic SJM valves was diagnosed by simultaneous transthoracic echocardiography and cineradiography (12,13). The method was the same as described in previous studies (12,13). Thrombolysis using warfarin, heparin, urokinase, and tissue plasminogen activator was performed in the PVD group (16). The treatment resulted in complete success in 4 patients, partial success in 7, and no change in 15.…”

Section: Methodsmentioning

confidence: 99%

“…The cause of pannus overgrowth is generally recognized as a bioreaction to the prosthesis (3,7), along with some coexisting factors as surgical techniques, thrombus organization from inadequate anticoagulation, infection, wall shear stress, and so on (3,8–11). In our previous studies (6,12–16), the high incidences of the obstruction in the aortic SJM valve (13), a problem in the protruding design of the pivot guard systems in the SJM valve (6), the expression of transforming growth factor beta (TGF‐β) and TGF‐β receptor type 1, and a provoked chronic inflammation with proliferation of myofibroblast, phagocyte, and extracellular matrix (15) were demonstrated.…”

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confidence: 90%

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Obstruction of St. Jude Medical Valves in the Aortic Position: Plasma Transforming Growth Factor Type Beta 1 in Patients With Pannus Overgrowth

et al. 2010

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The study investigated the hypothesis that plasma transforming growth factor type beta 1 (TGF-b1) initiated pannus overgrowth in cases with aortic prosthetic valve dysfunction (PVD). Patients with obstruction of an aortic St. Jude Medical valve in 26 cases (PVD group) and without obstruction in 48 cases (control group) were studied. Plasma TGF-b1, the intensity of the prothrombin time-international normalized ratio (PT-INR), and the interruption of an oral anticoagulant medicine were conducted. Plasma TGF-b1 levels in the PVD group (87.7 Ϯ 29.2 ng/mL) were significantly higher (P < 0.05) than in the control group (73.7 Ϯ 25.2 ng/mL).The interruption of an oral anticoagulant medicine in 54% of the PVD group versus 12% of the control group was identified (P < 0.001). The mean value of the PT-INR in the PVD group (1.75 Ϯ 0.30) and control group (1.75 Ϯ 0.30) was not significantly different (P = 0.82). In conclusion, elevated levels of plasma TGF-b1 may play a role in pannus overgrowth.

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Pannus formation in aortic valve prostheses in the late postoperative period

Kuniyoshi

Koja

Miyagi

et al. 2003

Journal of Artificial Organs

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We present three patients who underwent repeat aortic valve replacement for prosthetic valve dysfunction caused by tissue ingrowth in the late postoperative period. These patients (three women aged 48-51 years, mean 49.3 +/- 1.53 years) underwent operations for restriction of prosthetic valve leaflet movement by pannus in the left ventricular outflow tract. The interval from the previous operation ranged from 8.0 to 9.6 years (mean 9.6 +/- 2.0 years). The symptoms of the patients were New York Heart Association functional class I, II, and IV in one patient each. Diagnosis was made by cinefluoroscopy in two patients and aortography in one patient. The operative procedures consisted of aortic valve replacement ( n = 1) and aortic valve replacement with mitral valve replacement ( n = 2). Pannus was found at the left ventricular aspect of the prosthetic valve in all patients. In two patients, the pannus directly restricted movement of the leaflet and also severely narrowed the inflow orifice of the prosthetic valve. In the other patient, the pannus had grown at a distance of 7 mm from the valve and narrowed the left ventricular outflow tract circularly. The postoperative course was uneventful and all three patients were discharged in a good condition. One patient died of pneumonia 8 months after surgery and the other two patients have remained well and have been followed up for one and a half years. In conclusion, there may be a discrepancy between the clinical symptoms and the grade of subvalvular stenosis caused by pannus. Therefore, it is essential for satisfactory operative results that early diagnosis be made by various means.

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Asymptomatic Prosthetic Valve Dysfunction: Pannus?

Cited by 5 publications

References 5 publications

Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve

Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve

Obstruction of St. Jude Medical Valves in the Aortic Position: Plasma Transforming Growth Factor Type Beta 1 in Patients With Pannus Overgrowth

Pannus formation in aortic valve prostheses in the late postoperative period

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