Pannus-related prosthetic valve dysfunction, a complication of mechanical prosthetic valve replacement, is rare, with a slowly progressive evolution, but it can be acute, severe, requiring surgical reintervention. We present the case of a patient with a mechanical single disc aortic prosthesis, with moderate prosthesis-patient mismatch, minor pannus found on previous ultrasound examinations, who presented to our service with angina pain with a duration of 1 hour, subsequently interpreted as non-ST segment elevation myocardial infarction (NSTEMI) syndrome. Coronarography showed normal epicardial coronary arteries, an ample movement of the prosthetic disc, without evidence of coronary thromboembolism, and Gated Single-Photon Emission Computerized Tomography (SPECT) with Technetium (Tc)-99m detected no perfusion defects. Transthoracic echocardiography (TTE) evidenced a dysfunctional prosthesis due to a subvalvular mass; transesophageal echocardiography (TOE) showed the interference of this mass, with a pannus appearance, with the closure of the prosthetic disc. Under conditions of repeated angina episodes, under anticoagulant treatment, surgery was performed, with the intraoperative confirmation of pannus and its removal. Postoperative evolution was favorable. This case reflects the diagnostic and therapeutic management problems of pannus-related prosthetic valve dysfunction.
Sinus of Valsalva Aneurysm (SVA) is an aortic root anomaly, consisting of a lack of continuity between the aortic media and the aortic annulus, caused by a structural deficiency of muscular and elastic tissue. We present the case of a 49-year-oldman with atypical chest pain. Echocardiographic imaging described a giant unruptured aneurysm of the right sinus of Valsalva which was confirmed by cardiac computed tomography and coronary angiography. The obstruction of the right coronary artery without intravascular thrombosis and the compression of the right ventricular outflow tract with dynamic obstruction gradient represent the particularities of our case.
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