Early failure of a mechanical bileaflet aortic valve prosthesis due to pannus: A rare complication

Acute Obstruction by Pannus in Patients With Aortic Medtronic-Hall Valves: 30 years of Experience

“…Svennevig and colleagues [7] reported that female sex was a significant risk factor for death after aortic valve replacement, but possible reasons were not addressed. Some authors speculate that the higher rate of death in female patients after aortic valve replacement may be due to implantation of smaller prosthetic valves, resulting in higher bloodstream velocity and increased turbulence [2,4]. However, in our series, pannus obstruction occurred with all implanted valve sizes except 31-mm valves (Fig 2).…”

“…They reported pannus obstruction ranging from some days to 12 years postoperatively in their study on pathologic findings of obstructed mitral prosthetic valves. Kondruweit and colleagues [4] reported a case of valve obstruction caused by pannus 6 months after operation. Thus, it is clinically important to consider pannus as a cause of acute dysfunction, irrespective of time since the valve prosthesis implantation (Fig 1).…”

Rare early prosthesis obstruction after mitral valve replacement: a case report and literature review

“…Compared with valvular thrombosis, pannus is less frequently found to be an etiologic factor that contributes to the early PVD [2-8]. According to multiple clinical observations (Table 1), the duration from the time of prostheses implantation to pannus-induced PVD varies widely and has been reported to be 1.8 years to 23 years after surgery [4-7,9,10], and a shorter time interval (6 months) has been described in patient with the prosthetic aortic valve [8]. However, in this case, the time interval from the initial replacement to PVO caused by pannus ingrowth was extraordinarily short.…”

“…However, pannus is undoubtedly of later clinical onset than the thrombosis, which is mostly responsible for the early PVD. Moreover, the duration from time of prostheses implantation to pannus-induced PVD is widely variable and has been reported to be at least 6 months to 12 months, during which an ingrowth of periannular tissue would gradually immobilize the moving element of the prostheses [6-8]. Here we present a rare case of PVO in the mitral position caused by early pannus formation only 3 months after surgery.…”

Echocardiographic follow-up after heart valve replacement

“…While thrombus is often associated with dense surrounding spontaneous echo contrast, a history of suboptimal anticoagulation, and occurs more often on mitral than aortic prostheses due to higher flow velocities across the latter,12 pannus tends to be more echodense than thrombus, arises from the prosthetic ring suture line, and only rarely occurs early postoperatively 13. Nevertheless, both pathologies may coexist and often cannot be differentiated with confidence.…”