Early structural failure of a bioprosthetic mitral valve can occur within one year due to severe pannus formation and leaflet retraction, suggesting that bioprosthesis selection should be carefully considered even in elderly patients when performing chordal-sparing mitral valve replacement.
Hypothesis-generating for pannus-mediated early bioprosthetic mitral failure after chordal-sparing replacement; larger studies needed before changing valve selection.
症例は1年前に虚血性心筋症によるvalve tetheringを伴う虚血性僧帽弁閉鎖不全症に対し，Mosaic生体弁にて僧帽弁置換術を受けた70歳男性．術後半年目に生体弁弁尖1枚が可動しなくなり，高度僧帽弁逆流が出現した．内科的治療を行うも呼吸苦などの心不全症状を繰り返すため，初回手術から約1年後に再僧帽弁置換術を施行した．手術は右開胸でアプローチし，機械弁に再置換した．生体弁は肉眼的には僧帽弁後尖側に相当させた無冠尖部弁尖が退縮していた．組織学的には，同部位の左室側にパンヌスの過形成を認め，弁尖がパンヌスに絡まれる形で完全に退縮していた．
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Fukuoka et al. (2009) studied this question.
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