Imaging of the mechanical heart valve pannus formation with multidetector computerised tomography

A 56-year-old woman with a history of mechanical mitral valve replacement 9 years earlier, presented with signs of severe valve obstruction assessed by echocardiography (Fig. 1(A) and (B) , video 1). Multidetector computerised tomography clearly depicted pannus overgrowth as the cause of obstruction (Figs. 1(C), (D) and 2(A), (B)). She underwent re-replacement and the pannus was confirmed surgically (Fig. 2(C) and (D) ). Transthoracic Doppler echocardiography revealing severe obstruction of the mechanical valve (A). The cause of obstruction could not be visualised by trans-oesophageal echocardiography (B). Multiplanar reformatted images on contrast-enhanced 64-slice multidetector CT clearly depict a circular mass (arrows) with high HU values involving both atrial (C) and ventricular (D) sides of mechanical mitral valve suggestive of pannus formation. HU: Hounsfield unit, LA: left atrium, LV: left ventricle. Volume rendered reconstruction of MDCT images also demonstrating pannus formation (arrowheads indicate atrial side of pannus, and arrow indicates ventricular side of pannus) on atrial (A) and ventricular (B) sides. Narrowing of orifices by pannus overgrowth on both atrial (C) and ventricular (D) aspects demonstrated on surgically explanted mechanical mitral valve. LA: left atrium, LV: left ventricle. Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.ejcts.2010.01.013.