Three‐Dimensional Imaging of Pannus Overgrowth after Mitral Valve Repair

Abstract

We present the case of a 65-year-old man who was diagnosed with late mitral stenosis caused by pannus formation after Duran ring annuloplasty due to ischemicmitral regurgitation. Threedimensional echocardiography provided signifi cant information regarding the anatomy of the valve and the estimation of the severity of mitral stenosis.

How Does Mitral Valve Repair Fail in Patients With Prolapse?—Insights From Longitudinal Echocardiographic Follow-Up

“…Overall, the incidence of mitral stenosis late after mitral repair is rare. Case reports have described excess pannus formation after mitral annuloplasty with the Duran Annuloplasty, which occurred late after the initial repair [19,20]. Overall, the freedom from reoperation in this cohort was 97% at 5 years and 96% at 10 years after the repair, which agrees well with the published literature [5,[8][9][10].…”

Assessment of mitral annuloplasty ring by cardiac computed tomography: Correlation with echocardiographic parameters and comparison between two different ring types

“…In addition, grading the severity of MS in cases with pannus formation may be challenging, because Doppler parameters are not as reliable and planimetry at the level of the leaflet tips can be misleading because the level of obstruction is mainly at the level of the annuloplasty ring. 27 Cardiac CT can be helpful in this setting, because it allows direct estimation of the area where stenosis occurs.…”

Mitral Valve Stenosis after Open Repair Surgery for Non-rheumatic Mitral Valve Regurgitation: A Review

“…In most of these reports, MS developed after using a flexible Duran annuloplasty ring, with only one case developing with a rigid ring ( 17 ). In most cases, further echocardiographic assessment revealed that the MV leaflets were morphologically normal and the fibrous tissue predominantly formed at the level of the annuloplasty ring ( 18 ). In Nishida’s report, the fibrous tissue covered the Duran ring and also extended to the leaflets, which became stiff and immobile ( 16 ).…”

“…Duran rings also have a circular non-physiological shape, which can alter the normal saddle shape of the mitral annulus ( 22 ). Additionally, the templates used to deliver Duran rings require excessive contact around the valve and may result in injury to the leaflets ( 15 , 18 ).…”