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You are here: Contents > 2013 > Volume 22 Number 4 July 2013 > MISCELLANEOUS > Reoperation for Non-Structural Valvular Dysfunction Caused by Pannus Ingrowth in Aortic Valve Prosthesis

Reoperation for Non-Structural Valvular Dysfunction Caused by Pannus Ingrowth in Aortic Valve Prosthesis

Se Jin Oh1, Samina Park1, Jun Sung Kim2, Kyung-Hwan Kim1, Ki Bong Kim1, Hyuk Ahn1

1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 2Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea

Background and aim of the study: The authors’ clinical experience is presented of non-structural valvular dysfunction of the prosthetic aortic valve caused by pannus ingrowth during the late postoperative period after previous heart valve surgery.

Methods: Between January 1999 and April 2012, at the authors’ institution, a total of 33 patients underwent reoperation for increased mean pressure gradient of the prosthetic aortic valve. All patients were shown to have pannus ingrowth. The mean interval from the previous operation was 16.7 ± 4.3 years, and the most common etiology for the previous aortic valve replacement (AVR) was rheumatic valve disease. The mean effective orifice area index (EOAI) of the previous prosthetic valve was 0.97 ± 0.11 cm2/m2, and the mean pressure gradient on the aortic prosthesis before reoperation was 39.1 ± 10.7 mmHg.

Results: Two patients (6.1%) died in-hospital, and late death occurred in six patients (18.2%). At the first

operation, 30 patients underwent mitral or tricuspid valve surgery as a concomitant procedure. Among these operations, mitral valve replacement (MVR) was combined in 24 of all 26 patients with rheumatic valve disease. Four patients underwent pannus removal only while the prosthetic aortic valve was left in place. The mean EOAI after reoperation was significantly increased to 1.16 ± 0.16 cm2/m2 (p <0.001), and the mean pressure gradient was decreased to 11.9 ± 1.9 mmHg (p <0.001).

Conclusion: Non-structural valvular dysfunction caused by pannus ingrowth was shown in patients with a small EOAI of the prosthetic aortic valve and combined MVR for rheumatic disease. As reoperation for pannus overgrowth showed good clinical outcomes, an aggressive resection of pannus and repeated AVR should be considered in symptomatic patients to avoid the complications of other cardiac diseases.

The Journal of Heart Valve Disease 2013;22:591-598

Reoperation for Non-Structural Valvular Dysfunction Caused by Pannus Ingrowth in Aortic Valve Prosthesis

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