Prosthetic Aortic Valve Obstruction With Pannus Formation, an Approach for Diagnosis and Management: A Case Report
Mechanical valve obstructions are critical medical and surgical emergencies that require immediate attention when patients present with new complaints and exhibit signs such as the onset of murmurs or the disappearance of mechanical valve clicks. Obstructions can arise from various causes, including...
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Published in | Curēus (Palo Alto, CA) Vol. 15; no. 6; p. e40416 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Cureus Inc
14.06.2023
Cureus |
Subjects | |
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Abstract | Mechanical valve obstructions are critical medical and surgical emergencies that require immediate attention when patients present with new complaints and exhibit signs such as the onset of murmurs or the disappearance of mechanical valve clicks. Obstructions can arise from various causes, including pannus formation, thrombus, vegetations, or subvalvular tissue growth. While pannus formations have been previously reported for the mitral valve, they are less commonly observed in the aortic valve, and several hypotheses have been proposed to understand pannus formation. Accurate diagnosis relies on imaging techniques such as echocardiography and fluoroscopy, and surgical intervention is considered the optimal treatment approach. Here, we present the case of a 69-year-old female who had previously undergone aortic valve replacement and subsequently developed progressive dyspnea, fatigue, and a new onset murmur. Imaging modalities revealed a closed leaflet and a high transvalvular gradient over the valve. The patient underwent a prosthetic redo valve replacement, and post-surgery, she was discharged home without complications. |
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AbstractList | Mechanical valve obstructions are critical medical and surgical emergencies that require immediate attention when patients present with new complaints and exhibit signs such as the onset of murmurs or the disappearance of mechanical valve clicks. Obstructions can arise from various causes, including pannus formation, thrombus, vegetations, or subvalvular tissue growth. While pannus formations have been previously reported for the mitral valve, they are less commonly observed in the aortic valve, and several hypotheses have been proposed to understand pannus formation. Accurate diagnosis relies on imaging techniques such as echocardiography and fluoroscopy, and surgical intervention is considered the optimal treatment approach. Here, we present the case of a 69-year-old female who had previously undergone aortic valve replacement and subsequently developed progressive dyspnea, fatigue, and a new onset murmur. Imaging modalities revealed a closed leaflet and a high transvalvular gradient over the valve. The patient underwent a prosthetic redo valve replacement, and post-surgery, she was discharged home without complications. |
Author | Patel, Jigar Arshad, Hassaan Kakhktsyan, Tigran Mousa, Aliaa Desai, Harit Rashid, Muhammad Humayoun |
AuthorAffiliation | 3 Cardiovascular Medicine, Capital Health Regional Medical Center, Trenton, USA 2 Internal Medicine, Nishtar Medical University, Multan, PAK 1 Internal Medicine, Capital Health Regional Medical Center, Trenton, USA |
AuthorAffiliation_xml | – name: 2 Internal Medicine, Nishtar Medical University, Multan, PAK – name: 1 Internal Medicine, Capital Health Regional Medical Center, Trenton, USA – name: 3 Cardiovascular Medicine, Capital Health Regional Medical Center, Trenton, USA |
Author_xml | – sequence: 1 givenname: Aliaa surname: Mousa fullname: Mousa, Aliaa organization: Internal Medicine, Capital Health Regional Medical Center, Trenton, USA – sequence: 2 givenname: Hassaan surname: Arshad fullname: Arshad, Hassaan organization: Internal Medicine, Capital Health Regional Medical Center, Trenton, USA – sequence: 3 givenname: Tigran surname: Kakhktsyan fullname: Kakhktsyan, Tigran organization: Internal Medicine, Capital Health Regional Medical Center, Trenton, USA – sequence: 4 givenname: Muhammad Humayoun surname: Rashid fullname: Rashid, Muhammad Humayoun organization: Internal Medicine, Nishtar Medical University, Multan, PAK – sequence: 5 givenname: Jigar surname: Patel fullname: Patel, Jigar organization: Cardiovascular Medicine, Capital Health Regional Medical Center, Trenton, USA – sequence: 6 givenname: Harit surname: Desai fullname: Desai, Harit organization: Cardiovascular Medicine, Capital Health Regional Medical Center, Trenton, USA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37456415$$D View this record in MEDLINE/PubMed |
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Cites_doi | 10.32596/ejcm.galenos.2022.2022-09-046 10.1016/0735-1097(95)00018-Y 10.1016/S0022-5223(03)00702-5 10.1016/j.athoracsur.2013.07.019 10.1007/s12574-010-0064-7 10.1186/s40981-020-0313-3 10.7759/cureus.27198 10.4103/0975-2870.206577 10.1016/0735-1097(92)90389-5 |
ContentType | Journal Article |
Copyright | Copyright © 2023, Mousa et al. Copyright © 2023, Mousa et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright © 2023, Mousa et al. 2023 Mousa et al. |
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Keywords | fibro collagenous material fluroscopy prosthetic valve pannus aortic valve surgery mechanical thromb |
Language | English |
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References | Ellensen VS (ref4) 2013; 96 Ardehali A (ref3) 1995; 25 Inamdar A (ref9) 2017; 10 Teshima H (ref7) 2003; 126 Asil S (ref10) 2022; 10 Renzulli A (ref5) 1997; 6 Schwartz RS (ref8) 1992; 20 Muro T (ref1) 2011; 9 Panchal A (ref2) 2022; 14 Miyata K (ref6) 2020; 6 |
References_xml | – volume: 10 year: 2022 ident: ref10 article-title: Stuck leaflets in prosthetic heart valves with different etiology and treatments publication-title: E J Cardiovasc Med doi: 10.32596/ejcm.galenos.2022.2022-09-046 contributor: fullname: Asil S – volume: 25 year: 1995 ident: ref3 article-title: Coronary blood flow reserve in acute aortic regurgitation publication-title: J Am Coll Cardiol doi: 10.1016/0735-1097(95)00018-Y contributor: fullname: Ardehali A – volume: 126 year: 2003 ident: ref7 article-title: Obstruction of st jude medical valves in the aortic position: histology and immunohistochemistry of pannus publication-title: J Thorac Cardiovasc Surg doi: 10.1016/S0022-5223(03)00702-5 contributor: fullname: Teshima H – volume: 96 year: 2013 ident: ref4 article-title: Acute obstruction by pannus in patients with aortic medtronic-hall valves: 30 years of experience publication-title: Ann Thorac Surg doi: 10.1016/j.athoracsur.2013.07.019 contributor: fullname: Ellensen VS – volume: 9 year: 2011 ident: ref1 article-title: Intermittent chest pain with marked ST depression after 13 years of aortic valve replacement publication-title: J Echocardiogr doi: 10.1007/s12574-010-0064-7 contributor: fullname: Muro T – volume: 6 year: 2020 ident: ref6 article-title: Intraoperative detection of stuck leaflet after implantation of a mechanical aortic valve: a case report publication-title: JA Clin Rep doi: 10.1186/s40981-020-0313-3 contributor: fullname: Miyata K – volume: 14 year: 2022 ident: ref2 article-title: Acute severe aortic regurgitation from catastrophic pannus obstruction in a patient with mechanical aortic valve replacement publication-title: Cureus doi: 10.7759/cureus.27198 contributor: fullname: Panchal A – volume: 10 year: 2017 ident: ref9 article-title: Prosthetic valve obstruction: redo surgery or fibrinolysis? publication-title: Med J Dr. D.Y. Patil University doi: 10.4103/0975-2870.206577 contributor: fullname: Inamdar A – volume: 6 year: 1997 ident: ref5 article-title: Thrombolysis for prosthetic valve thrombosis: indications and results publication-title: J Heart Valve Dis contributor: fullname: Renzulli A – volume: 20 year: 1992 ident: ref8 article-title: The restenosis paradigm revisited: an alternative proposal for cellular mechanisms publication-title: J Am Coll Cardiol doi: 10.1016/0735-1097(92)90389-5 contributor: fullname: Schwartz RS |
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SubjectTerms | Anticoagulants Auscultation Blood clots Cardiac/Thoracic/Vascular Surgery Cardiology Case reports Extracellular matrix Growth factors Heart Hyperplasia Medical diagnosis Pathology Patients Prostheses Thrombosis Ultrasonic imaging |
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Title | Prosthetic Aortic Valve Obstruction With Pannus Formation, an Approach for Diagnosis and Management: A Case Report |
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