title: Subvalvular Pannus Overgrowth after Mosaic Bioprosthesis Implantation in the Aortic Position.
abstract: OBJECTIVE
  Although pannus overgrowth by itself was not the pathology of structural valve deterioration (SVD), it might be related to reoperation for SVD of the bioprostheses.
  
  
  METHODS
  We retrospectively reviewed patients undergoing reoperation for SVD after implantation of the third-generation Mosaic aortic bioprosthesis and macroscopic appearance of the explanted valves was examined to detect the presence of pannus.
  
  
  RESULTS
  There were 10 patients and the age for the initial aortic valve replacement was 72 ± 10 years old. The duration of durability was 9.9 ± 2.0 years. Deteriorated valve presented stenosis (valvular area of 0.96 ± 0.20 cm(2); pressure gradient of 60 ± 23 mmHg). Coexisting regurgitant flow was detected in two cases. Macroscopically, subvalvular pannus overgrowth was detected in 8 cases (80%). The proportion of overgrowth from the annulus was almost even and pannus overgrowth created subvalvular membrane, which restricted the area especially for each commissure. In contrast, opening and mobility of each leaflet was not severely limited and pannus overgrowth would restrict the area, especially for each commissure. In other two cases with regurgitation, tear of the leaflet on the stent strut was detected and mild calcification of each leaflet restricted opening.
  
  
  CONCLUSIONS
  In patients with the Mosaic aortic bioprosthesis, pannus overgrowth was the major cause for reoperation.
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Hirota
authors.forename: Tadashi
authors.initials: T
authors.lastname: Isomura
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshida
authors.forename: Chieko
authors.initials: C
authors.lastname: Katsumata
authors.forename: Fusahiko
authors.initials: F
authors.lastname: Ito
authors.forename: Masazumi
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D020878:Device Removal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome