Author + information
- Received July 22, 2014
- Revision received December 15, 2014
- Accepted December 18, 2014
- Published online December 1, 2015.
- Sahmin Lee, MD∗,
- Seung-Pyo Lee, MD∗∗ (, )
- Eun-Ah Park, MD†,
- Mi-Kyeong Hong, RDCS∗,
- Ji-Hyun Kim, MD‡,
- Hyung-Kwan Kim, MD∗,
- Whal Lee, MD†,
- Yong-Jin Kim, MD∗ and
- Dae-Won Sohn, MD∗
- ∗Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- †Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- ‡Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
- ↵∗Reprint requests and correspondence:
Dr. Seung-Pyo Lee, Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea 110-744.
- mechanical aortic valves
- pannus formation
- real-time three-dimensional transesophageal echocardiography
Subvalvular pannus formation is a rare but clinically important complication that can be missed in patients with prosthetic valves (1). The only definite treatment for patients with prosthetic valve obstruction as a result of pannus ingrowth is reoperation. However, currently available methodologies are not sufficient to diagnose subvalvular pannus formation especially in mechanical aortic valves (2). We explored a series of experiences with 3-dimensional transesophageal echocardiography (3D-TEE) for the visualization and accurate assessment of subvalvular pannus in patients with mechanical aortic valve (Figures 1 to 4⇓⇓⇓⇓, Online Videos 1A, 1B, 2A, and 2B). We prospectively enrolled 11 patients (mean age 64.0 ± 8.6 years, 10 patients with either double or triple valve replacement) who had previously implanted mechanical aortic valve, with transaortic mean pressure gradient >40 mm Hg or transaortic maximal velocity >4 m/s despite normal occluder motion. All patients underwent 3D-TEE examination to rule out pannus formation and these findings were compared with multidetector computed tomography images and/or surgical findings.
Real-time 3D-TEE can be useful for visualizing subaortic pannus in mechanical aortic valves. Using 3D planimetry, quantitative measurement of geometric subvalvular area at the level of the pannus is feasible and has good correlation with the area measured by multidetector computed tomography and also with the Doppler measurement by transthoracic echocardiography.
For supplemental videos, please see the online version of this article.
This study was supported by a grant from the Korean Health Technology R&D Project funded by the Ministry of Health, Welfare & Family Affairs (A120753). All have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 22, 2014.
- Revision received December 15, 2014.
- Accepted December 18, 2014.
- 2015 American College of Cardiology Foundation
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- Nagueh S.F.,
- Pitsavos C.,
- Toutouzas P.K.,
- Quinones M.A.,
- Zoghbi W.A.