Soumoulou JB, Cianciulli TF, Zappi A, Cozzarin A, Saccheri MC, Lax JA, Guidoin R, Zhang Z. Limitations of multimodality imaging in the diagnosis of pannus formation in prosthetic aortic valve and review of the literature. World J Cardiol 2015; 7(4): 224-229 [PMID: 25914791 DOI: 10.4330/wjc.v7.i4.224]
Corresponding Author of This Article
Tomás Francisco Cianciulli, MD, FACC, Director Echocardiography Laboratory, Department of Cardiology, Hospital “Dr. Cosme Argerich”, Pi y Margall 750, Ciudad Autónoma de Buenos Aires C1155AHD, Argentina. tcianciulli@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2015; 7(4): 224-229 Published online Apr 26, 2015. doi: 10.4330/wjc.v7.i4.224
Limitations of multimodality imaging in the diagnosis of pannus formation in prosthetic aortic valve and review of the literature
Juan Bautista Soumoulou, Tomás Francisco Cianciulli, Andrea Zappi, Alberto Cozzarin, María Cristina Saccheri, Jorge Alberto Lax, Robert Guidoin, Ze Zhang
Juan Bautista Soumoulou, Tomás Francisco Cianciulli, Alberto Cozzarin, María Cristina Saccheri, Jorge Alberto Lax, Department of Cardiology, Hospital “Dr. Cosme Argerich”, Ciudad Autónoma de Buenos Aires C1155AHD, Argentina
Tomás Francisco Cianciulli, Researcher of the Ministry of Health, Government of the City of Buenos Aires, Argentina C1035AAN, Argentina
Andrea Zappi, Department of Pathology, Hospital “Dr. Cosme Argerich”, Ciudad Autónoma de Buenos Aires C1155AHD, Argentina
Robert Guidoin, Ze Zhang, Department of Surgery and Radiology, Laval University and Québec Biomaterials Institute, CHUQ, Quebec G1K 7P4, Canada
Author contributions: Cianciulli TF and Cozzarin A attended the patient; Soumoulou JB and Saccheri MC prepared the manuscript and figures; Zappi A performed pathology examination; Lax JA performed the echocardiographic images and participated in the manuscript description; Guidoin R and Zhang Z participated in the design and review of the manuscript; all authors read and approved the final manuscript.
Ethics approval: This case report was reviewed and approved by the Hospital of the Government of the City of Buenos Aires “Dr. Cosme Argerich” Institutional Review Board.
Informed consent: The patient of this case report, provided informed written consent prior to publication.
Conflict-of-interest: There is no conflict of interest concerning this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tomás Francisco Cianciulli, MD, FACC, Director Echocardiography Laboratory, Department of Cardiology, Hospital “Dr. Cosme Argerich”, Pi y Margall 750, Ciudad Autónoma de Buenos Aires C1155AHD, Argentina. tcianciulli@gmail.com
Telephone: +54-11-41210879 Fax: +54-11-48015510
Received: November 11, 2014 Peer-review started: November 11, 2014 First decision: December 26, 2014 Revised: February 7, 2015 Accepted: February 10, 2015 Article in press: February 12, 2015 Published online: April 26, 2015 Processing time: 160 Days and 4.4 Hours
Abstract
Pannus formation is a rare complication and occurs almost exclusively in mechanical prosthetic valves. It consists of fibrous tissue that covers the surface of the prosthesis either concentrically or eccentrically, resulting in valve dysfunction. The pathophysiology seems to be associated to a chronic inflammatory process that explains the late and insidious clinical presentation. This diagnosis should be considered in patients with high transvalvular gradients on transthoracic echo, and workup should be completed with fluoroscopy and transesophageal echocardiography. Treatment is always surgical and recurrence is rare. We present a case of pannus formation in a prosthetic aortic valve and a review of the literature regarding this disorder.
Core tip: Pannus is an infrequent complication that mainly affects mechanical prosthetic valves. Its diagnosis requires clinical suspicion and the association of fluoroscopy, transthoracic and transesophageal echocardiography. The case presented is a characteristic example of pannus, given its clinical presentation (progressive dyspnea), the steps followed to reach diagnosis and the surgical resolution. Suspecting this disorder and making an accurate diagnosis is of paramount importance, to implement adequate treatment and to avoid prolonging the natural course of the disease and its repercussion on the left ventricle and the quality of life of affected patients.
