title: Pannus-related prosthetic valve dysfunction. Case report.
abstract: Pannus-related prosthetic valve dysfunction, a complication of mechanical prosthetic valve replacement, is rare, with a slowly progressive evolution, but it can be acute, severe, requiring surgical reintervention. We present the case of a patient with a mechanical single disc aortic prosthesis, with moderate prosthesis-patient mismatch, minor pannus found on previous ultrasound examinations, who presented to our service with angina pain with a duration of 1 hour, subsequently interpreted as non-ST segment elevation myocardial infarction (NSTEMI) syndrome. Coronarography showed normal epicardial coronary arteries, an ample movement of the prosthetic disc, without evidence of coronary thromboembolism, and Gated Single-Photon Emission Computerized Tomography (SPECT) with Technetium (Tc)-99m detected no perfusion defects. Transthoracic echocardiography (TTE) evidenced a dysfunctional prosthesis due to a subvalvular mass; transesophageal echocardiography (TOE) showed the interference of this mass, with a pannus appearance, with the closure of the prosthetic disc. Under conditions of repeated angina episodes, under anticoagulant treatment, surgery was performed, with the intraoperative confirmation of pannus and its removal. Postoperative evolution was favorable. This case reflects the diagnostic and therapeutic management problems of pannus-related prosthetic valve dysfunction.
authors.affiliation: Cardiology Department, Niculae Stăncioiu Heart Institute, Cluj-Napoca, Romania.
authors.forename: Maria-Sînziana
authors.initials: MS
authors.lastname: Moldovan
authors.affiliation: Cardiology Department, Niculae Stăncioiu Heart Institute, Cluj-Napoca, Romania; Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bedeleanu
authors.affiliation: Cardiology Department, Niculae Stăncioiu Heart Institute, Cluj-Napoca, Romania.
authors.forename: Emese
authors.initials: E
authors.lastname: Kovacs
authors.affiliation: Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Internal Medicine Department, CF University Hospital, Cluj-Napoca, Romania.
authors.forename: Lorena
authors.initials: L
authors.lastname: Ciumărnean
authors.affiliation: Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Clinic of Cardiovascular Surgery, Niculae Stăncioiu Heart Institute, Cluj-Napoca, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Molnar
keywords: acute coronary syndrome; echocardiography; pannus; prosthetic valve dysfunction; surgery