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

Abstract

As a dreadful complication after the mechanical heart valve replacement, prosthetic valve obstruction caused by pannus formation occurs increasingly with time. The authors here present a case of 42-year-old woman who was urgently admitted to hospital with acute heart failure symptoms due to the mechanical mitral valve failure only 3 months after surgery. Transthoracic and transesophageal echocardiography demonstrated that the bileaflet of the mitral prosthesis were completely immobilized with only a small transvalvular jet remained. During the reoperation, the reason of the prosthetic valve obstruction was attributed to the noncircular pannus ingrowth extending from the atrioventricular side. For a better understanding of the prosthetic valve dysfunction caused by pannus formation, the authors then compile a literature review to briefly discuss the status quo of the clinical characteristics of this uncommon complication.

Experimental investigation of the flow downstream of a dysfunctional bileaflet mechanical aortic valve

“…BMHV dysfunction may appear at anytime between 1 hour and 20 years (median: 44.5 months) following the primary valve replacement . Its reported incidence rate ranges between 0.1% and 6.0% and it represents a major life‐threatening event associated with a significantly high mortality rate in emergency (28.6%) . BMHV dysfunction is due to thrombus formation (41%), to pannus growth (38%) or to both (21%).…”

Early re-replacement after mitral valve replacement using the chimney technique in a child: a case report

“…Pannus formation after prosthetic valve replacement is an important complication. It usually occurs in the late post-operative period, but Shi et al 3 and Al-Alao et al 4 reported a case of re-replacement as short as 3 months post-operatively. Beierlein et al 5 reported that re-replacement was needed 7.5 years post-operatively and that all patients had variable degrees of pannus in childhood.…”

Investigation of a Mechanical Valve Impairment after Eight Years of Implantation

“…[10] Nevertheless, prosthetic valve obstruction after the mechanical heart valve replacement caused by pannus occurs increasingly with time, with a later clinical onset than thrombosis (frequently involved in the early impairment). Having in mind that the time interval between graft implantation and occurrence of pannus-induced dysfunction has been reported to be 1.8 years to 23 years after surgery [2], and no direct evidences of thrombosis in the heart cavities, the diagnosis suspicion was pannus-induced impairment. Due to progressive dyspnea and increasing transvalvular pressure gradient, the open surgery was performed, to avoid hemodynamic deterioration of the patient.…”

“…The design and biomaterials of mechanical heart valves have evolved significantly, along with their in vivo hemodynamic characteristics [1]. However, the outcome of mechanical valve grafts implantation may still be compromised by the occurrence of complications like thrombosis, or abnormal tissue formation, as pannus [2]. We here investigate the impairment of a mechanical graft after eight years of implantation due to an abnormal tissue proliferation affecting a valve's leaflet.…”