Pannus formation in aortic valve prostheses in the late postoperative period

Kuniyoshi, Yukio; Koja, Kageharu; Miyagi, Kazufumi; Shimoji, Mituyoshi; Uezu, Tooru; Arakaki, Katsuya; Yamashiro, Satoshi; Mabuni, Katsuhito; Senaha, Shigenobu; Nakasone, Yoshiyuki

doi:10.1007/s10047-003-0226-8

Cited by 20 publications

(21 citation statements)

References 9 publications

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“…This finding may suggest that pannus formation does not cause any abnormality on TTE when it presents in minimal to mild degrees, but when it progresses to moderate to severe degrees, it can cause LVOT obstruction, and subsequently lead to PG elevation or LOM. These results were consistent with those of previous studies [19,20], which suggested that the hemodynamic effect of pannus formation depends on the extent and site of fibrous tissue. Pannus arising from the neointima in the periannulus of the left ventricular septum [21], may extend to the orifice and hinges of the prosthetic valve which results in restriction of either or both leaflets leading to severe narrowing of the inflow orifice, or severe stenosis may occur due to the narrowing of the LVOT by a circumferential pannus without restricting leaflet motion [19,20].…”

Section: Discussionsupporting

confidence: 93%

“…These results were consistent with those of previous studies [19,20], which suggested that the hemodynamic effect of pannus formation depends on the extent and site of fibrous tissue. Pannus arising from the neointima in the periannulus of the left ventricular septum [21], may extend to the orifice and hinges of the prosthetic valve which results in restriction of either or both leaflets leading to severe narrowing of the inflow orifice, or severe stenosis may occur due to the narrowing of the LVOT by a circumferential pannus without restricting leaflet motion [19,20]. In our study, the pannus was most frequently located at zone 1, which indicated the septal side of left ventricle, and the circumferential location was the second most common site.…”

Section: Discussionsupporting

confidence: 93%

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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: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

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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“…Other authors indicate degeneration of a bioprosthesis as the most frequent cause of redo surgery as well [7, 17]. Each patient whose survival time is long enough needs redo surgery and this is connected with the limited durability of a bioprosthesis [18]. Taking that into account, it is proposed that implantation of bioprostheses be limited to patients over the age of 65.…”

Section: Discussionmentioning

confidence: 99%

Redo surgery risk in patients with cardiac prosthetic valve dysfunction

Maciejewski¹,

Piestrzeniewicz²,

Bielecka‐Dąbrowa³

et al. 2011

aoms

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IntroductionThe aim of the study was to analyse the risk factors of early and late mortality in patients undergoing the first reoperation for prosthetic valve dysfunction.Material and methodsA retrospective observational study was performed in 194 consecutive patients (M = 75, F = 119; mean age 53.2 ±11 years) with a mechanical prosthetic valve (n = 103 cases; 53%) or bioprosthesis (91; 47%). Univariate and multivariate Cox statistical analysis was performed to determine risk factors of early and late mortality.ResultsThe overall early mortality was 18.6%: 31.4% in patients with symptoms of NYHA functional class III-IV and 3.4% in pts in NYHA class I-II. Multivariate analysis identified symptoms of NYHA class III-IV and endocarditis as independent predictors of early mortality. The overall late mortality (> 30 days) was 8.2% (0.62% year/patient). Multivariate analysis identified age at the time of reoperation as a strong independent predictor of late mortality.ConclusionsReoperation in patients with prosthetic valves, performed urgently, especially in patients with symptoms of NYHA class III-IV or in the case of endocarditis, bears a high mortality rate. Risk of planned reoperation, mostly in patients with symptoms of NYHA class I-II, does not differ from the risk of the first operation.

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“…Inhibiting intima hypertrophy and degeneration in the valve might be important to sustain valvular flexibility and function [18,25]. Metabolites from the blood contact the surface of heart valvular tissue through direct diffusion [28].…”

Section: Discussionmentioning

confidence: 99%

Histological Study of Right Ventricle-Pulmonary Artery Valved Conduit Implantation (RPVC) in Dogs with Pulmonic Stenosis

Saida

Tanaka

Fukushima

et al. 2009

The Journal of Veterinary Medical Science

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ABSTRACT. We examined whether right ventricle-pulmonary artery valved conduit (RPVC) implantation can overcome the disadvantages of current procedures for pulmonic stenosis (PS). We histologically evaluated the feasibility of RPVC using a homograft in PS model dogs. Eight dogs underwent pulmonary artery banding (PAB) and then 12 weeks later were assigned to PAB (n=4) or PAB+RPVC (n=4) groups. Dogs in the PAB group received no treatment throughout the experimental period, whereas the PAB+RPVC group underwent RPVC. At 1 year after PAB, hearts and conduits were explanted from euthanized dogs and histologically evaluated. The ratios (%) of myocardial fibrosis on right ventricle (RV) epicardial, median and endocardial layers were significantly lower in the PAB+RPVC, than in the PAB group. The ratio of myocardial fibrosis on left ventricular (LV) epicardial and endocardial layers were significantly lower in the PAB+RPVC, than in the PAB group. Neo-intimal thickness in the anastomosis areas of the Denacol and PAB+RPVC groups was 42.77  30.19 and 88.30  27.24 m, respectively, with no significant differences between the groups. Calcification and neo-intima hypertrophy were not obvious in the valve area. Immunohistological staining showed that the internal surface of the anastomosis and intermediate areas were positive for endothelial cells. We concluded that RPVC using a bioprosthetic graft can apparently overcome the disadvantages of current procedures for pulmonic stenosis. KEY WORDS: endotherialization, myocardial fibrosis, pulmonary artery banding, pulmonic stenosis, valved conduit.J. Vet. Med. Sci. 71(4): 409-415, 2009 Pulmonic stenosis (PS) is a relatively frequent congenital narrowing of the right ventricular outflow tract that occurs in about 0.1% of all dogs [9]. Strategies for treating severe pulmonic stenosis include transventricular pulmonic dilation [8], closed patch-graft [3,24], open patch-graft [12] and balloon dilation [4,6,14,15] valvuloplasty. Patch-graft valvuloplasty is an effective radical treatment for PS, but it requires a cardiopulmonary bypass to stabilize the circulation, which cannot be performed at many institutions [21]. On the other hand, although balloon dilation valvuloplasty is a popular strategy, the results are inferior in dogs with PS accompanied by dysplasia of the pulmonic annulus and main pulmonary artery to those in dogs with PS alone [6]. Thus, we considered right ventricle (RV)-pulmonary artery valved conduit (RPVC) implantation to overcome the disadvantages of the current procedures. Implantation with the RPVC decreases right ventricular systolic pressure by forming a bypass and the procedure is less invasive because it can be performed under the beating heart. A bioprosthetic valved conduit has been used for RVOT reconstruction in humans [2]. Denacol-treated bioprosthetic implanted conduits are better assimilated and organized with the blood vasculature [19]; they are also thrombo-resistant and do not provoke the immune response [13]. Furthermore, the valve in the condu...

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Pannus formation in aortic valve prostheses in the late postoperative period

Cited by 20 publications

References 9 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

Redo surgery risk in patients with cardiac prosthetic valve dysfunction

Histological Study of Right Ventricle-Pulmonary Artery Valved Conduit Implantation (RPVC) in Dogs with Pulmonic Stenosis

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