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.
Highlights
The evolving design and biomaterials of the mechanical heart valves have greatly advanced their in vivo hemodynamic features and durability over decades [1]
The anticipated performances of the mechanical prostheses are still compromised by the occurrence of various complications, among which pannus-induced prosthetic valve dysfunction (PVD) is relatively uncommon but sometimes is the most serious one [2,3]
Pannus is undoubtedly of later clinical onset than the thrombosis, which is mostly responsible for the early PVD
Summary
The evolving design and biomaterials of the mechanical heart valves have greatly advanced their in vivo hemodynamic features and durability over decades [1]. The anticipated performances of the mechanical prostheses are still compromised by the occurrence of various complications, among which pannus-induced prosthetic valve dysfunction (PVD) is relatively uncommon but sometimes is the most serious one [2,3]. Patients with prosthetic valve obstruction (PVO) due to pannus ingrowth may rapidly develop hemodynamic deterioration and crash into a life-threatening condition. No episode of atrial fibrillation and other risk factors for thrombus formation were identified One week before this admission, she had noticed a progressive physical deterioration. After the treatment at local hospital, the patient showed no signs of recovery and presented with severe shortness of breath and coughing up pink, foamy mucus on the arrival of our hospital. The postoperative course was regular and in-hospital TTE showed normal functioning of the newly implanted mitral prosthesis. On microscopic examination (Figure 3), the resected pannus tissue was found to be mainly constituted with infiltrated leukocytes (neutrophils, macrophages, lymphocytes and plasma cells), pleomorphic spindle cells such as myofibroblasts, and interspersed capillary vessels
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