J Cardiovasc Ultrasound.  2013 Dec;21(4):189-191. 10.4250/jcu.2013.21.4.189.

Intermittent, Non Cyclic Severe Mechanical Aortic Valve Regurgitation

• Choi JH
• Choi JH
• Song S
• Lee MY

• KMID: 2135419
• DOI: http://doi.org/10.4250/jcu.2013.21.4.189

Abstract

Mechanical aortic prosthesis dysfunction can result from thrombosis or pannus formation. We describe an unusual case of intermittent, non cyclic mechanical aortic prosthesis dysfunction due to pannus formation with thrombus in the absence of systolic restriction of disk excursion, that presented with intermittent severe aortic regurgitation.

Keyword

Intermittent aortic regurgitation; Acute prosthetic valve dysfunction; Pannus; Echocardiography

MeSH Terms

Aortic Valve Insufficiency
Aortic Valve*
Echocardiography
Prostheses and Implants
Thrombosis

Figure

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  Fig. 1 Transesophageal echocardiography showed normal systolic excursion of the occluding disk (A) and color Doppler revealed intermittent non cyclic severe acute aortic valve regurgitation (B).

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  Fig. 2 Two-dimensional transesophageal echocardiography (A) and real time 3-dimensional transesophageal echocardiography (B) showed a small less mobile echogenic mass in the outflow tract immediately above the prosthesis consistent with pannus formation on which possible thrombus superimposed.

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  Fig. 3 On surgical finding, focal pannus formation above the aortic prosthesis was noticed.

Reference

1. Bouma BJ, Koster R. Dysfunction of an aortic prosthetic valve. Heart. 2005; 91:1120.

2. Robles P, Jimenez Nacher JJ, Rubio A, Huelmos A, Lopez L. Intermittent aortic regurgitation in a case of mechanical prosthesis dysfunction. Int J Cardiol. 2005; 102:525–527.

3. Galli CA, Muratori M, Montorsi P, Barili F, Polvani G, Pepi M. Cyclic intermittent aortic regurgitation of a mechanical bileaflet aortic valve prosthesis: diagnosis and clinical implications. J Am Soc Echocardiogr. 2007; 20:1315.e5–1315.e8.

4. Karagiannis SE, Karatasakis G, Spargias K, Louka L, Poldermans D, Cokkinos DV. Intermittent acute aortic valve regurgitation: a case report of a prosthetic valve dysfunction. Eur J Echocardiogr. 2008; 9:291–293.

5. Cianciulli TF, Saccheri MC, Lax JA, Guidoin R, Zhang Z, Guerra JE, Prezioso HA, Vidal LA. Intermittent acute aortic regurgitation of a mechanical bileaflet aortic valve prosthesis: diagnosis and clinical implications. Eur J Echocardiogr. 2009; 10:446–449.

6. Giroux SK, Labinaz MX, Grisoli D, Klug AP, Veinot JP, Burwash IG. Intermittent, noncyclic dysfunction of a mechanical aortic prosthesis by pannus formation. J Am Soc Echocardiogr. 2010; 23:107.e1–107.e3.

7. Teshima H, Hayashida N, Yano H, Nishimi M, Tayama E, Fukunaga S, Akashi H, Kawara T, Aoyagi S. Obstruction of St Jude Medical valves in the aortic position: histology and immunohistochemistry of pannus. J Thorac Cardiovasc Surg. 2003; 126:401–407.

8. Barbetseas J, Nagueh SF, Pitsavos C, Toutouzas PK, Quiñones MA, Zoghbi WA. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol. 1998; 32:1410–1417.

9. Rizzoli G, Guglielmi C, Toscano G, Pistorio V, Vendramin I, Bottio T, Thiene G, Casarotto D. Reoperations for acute prosthetic thrombosis and pannus: an assessment of rates, relationship and risk. Eur J Cardiothorac Surg. 1999; 16:74–80.