Extent of Subprosthetic Pannus after Aortic Valve Replacement: Changes Over Time and Relationship with Echocardiographic Findings

Figures

• 

  Fig. 1. Study patients. AVR = aortic valve replacement

• 

  Fig. 2. A 42-year-old female who underwent aortic valve replacement using a 21-mm St. Jude valve 5 years ago. A. Initial CT image shows pannus formation (arrowheads); maximal width, 2.7 mm; pannus area, 40.16 mm2; and effective orifice area, 275.84 mm2. B. After 3 years, the pannus extent (arrowheads) has increased to 3.8 mm, 103.12 mm2, and 204.86 mm2, respectively. C. Transthoracic echocardiography can not demonstrate the subvalvular pannus because of a poor sonic window. D. Doppler echocardiography shows flow acceleration. The peak and mean transvalvular pressure gradients changed from 34 to 67 mm Hg and 18 to 37 mm Hg, respectively.

• 

  Fig. 3. Graphs demonstrate interval changes of the pannus extent. A. In general, the effective orifice area is seen to be decreased on follow-up CT. B–D. The pannus area (B), encroachment ratio (C), and pannus (D) involvement angle are increased.

• 

  Fig. 4. A 56-year-old female who had undergone AVR using an 18 mm ATS valve 14 years earlier. A. The initial CT scan shows subvalvular pannus formation (arrowheads). The maximal pannus width is 3 mm, the pannus area is 36.2 mm2, and the effective orifice area is 186.9 mm2. B. Two years later, the pannus extent (arrowheads) increases to 5 mm, 115.5 mm2, and 101.9 mm2, respectively. C. The prosthetic aortic valve shows limitation of motion (mean opening angle 56.5°). D. On Doppler echocardiography, eccentric flow acceleration is observed along the wall of the aortic root. E. 3D transesophageal echocardiography shows eccentric pannus formation (arrowheads). The peak and mean transvalvular pressure gradients are changed from 84 to 88 mm Hg and 52 to 57 mm Hg, respectively. F. During the redo-AVR, subvalvular pannus entirely involving the valve is confirmed. AO = aortica root, AVR = aortic valve replacement, LA = left atrium, LV = left ventricle