Abudiab MM, McKay J, Deavers M, Zoghbi WA, Chang SM. Pannus of Mitral Valve Prosthesis Causing Left Ventricular Outflow Tract Obstruction. Methodist DeBakey Cardiovasc  J. 2016;12(3):183." /> Abudiab MM, McKay J, Deavers M, Zoghbi WA, Chang SM. Pannus of Mitral Valve Prosthesis Causing Left Ventricular Outflow Tract Obstruction. Methodist DeBakey Cardiovasc  J. 2016;12(3):183."> Article Full Text – Methodist Journal
Methodist Journal

IN THIS ISSUE

Lipids and Lipoproteins

Vol 15, Issue 1 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

Lipids and Cardiovascular Disease: Putting it All Together

See More
RECOGNITIONS

Guest Editors Henry Pownall and Antonio Gotto Offer Insight and Expertise on the topic of Lipids and Cardiovascular Disease

See More

REVIEW ARTICLES See More

Cholesterol: Can’t Live With It, Can’t Live Without It

How Much Do Lipid Guidelines Help the Clinician? Reading Between the (Guide)lines

Statins: Then and Now

Poststatin Lipid Therapeutics: A Review

HDL and Reverse Cholesterol Transport Biomarkers

Revisiting Reverse Cholesterol Transport in the Context of High-Density Lipoprotein Free Cholesterol Bioavailability

High-Density Lipoprotein Subspecies in Health and Human Disease: Focus on Type 2 Diabetes

Gene Delivery in Lipid Research and Therapies

CASE REPORTS See More

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

Loperamide Mimicking Brugada Pattern

Reversed Pulsus Paradoxus in Right Ventricular Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Transcatheter Embolization of a Persistent Vertical Vein: A Rare Cause of Left-to-Right Shunt and Right-Sided Heart Failure

CLINICAL PERSPECTIVES See More

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

POINTS TO REMEMBER

The Kidney as an Endocrine Organ

EDITORIALS

Addressing the Underrepresentation of Women in Cardiology through Tangible Opportunities for Mentorship and Leadership

Vol 12, Issue 3 (2016)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

Pannus of Mitral Valve Prosthesis Causing Left Ventricular Outflow Tract Obstruction

Jump to:
Article Citation:

Abudiab MM, McKay J, Deavers M, Zoghbi WA, Chang SM. Pannus of Mitral Valve Prosthesis Causing Left Ventricular Outflow Tract Obstruction. Methodist DeBakey Cardiovasc  J. 2016;12(3):183.

doi: https://doi.org/10.14797/mdcj-12-3-183

Keywords
mitral valve replacement , stenosis , pannus , cardiovascular imaging

 

A 54-year-old female with mitral valve replacement presented to the Houston Methodist Hospital with chest pain and dyspnea. (A) Transthoracic echocardiography (TTE) demonstrated marked left ventricular outflow tract (LVOT) narrowing and a frozen aortic valve (AV) cusp (Video 1). (B) Spectral Doppler by TTE across the AV revealed high velocity with rounded contour. (C) Cardiac computed tomography (CT) confirmed suspicion that these findings were referable to extensive pannus formation involving the bioprosthetic mitral valve (Video 2). (D) Following surgical resection, the LVOT appeared normal on TTE. (E) Postoperative cardiac CT also showed return of normal AV leaflet excursion. (F) Pathology of the resected tissue was consistent with pannus, evidenced by fibrous tissue with hypocellular proliferation of bland spindle cells, abundant collagen, and scattered capillaries. TTE also revealed mild stenosis of the mitral prosthesis, with a mean diastolic gradient of 6 mm Hg.

While pannus can develop on both bioprosthetic and mechanical valves in the mitral position,1 extension into either adjoining cavity is unusual, typically involves only the left atrium, and is more typical of thrombosis.2 This is an interesting presentation since LVOT obstruction due to pannus of a mitral prosthesis is rarely seen.


Video 1: TTE shows LVOT narrowing and frozen AV cusp


Video 2: CT demonstrates pannus of bioprosthetic mitral valve

References
1. Pibarot P Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009 Feb 24; 119( 7): 103448.
2. Barbetseas J , Nagueh SF , Pitsavos C , Toutouzas PK , Quinones MA , Zoghbi WA. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol. 1998 Nov; 32( 5): 14107.

Add Comments

Please login to dialogue with author.

Comments