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Eur J Cardiothorac Surg 2002;22:312
© 2002 Elsevier Science NL

Images in cardio-thoracic surgery

Thrombotic pannus causing mixed prosthetic mitral valve dysfunction

Darryl A. Chung, Eoin N. Sherry, John B. Chambers, Christopher I. Blauth*

Cardiothoracic Centre, St. Thomas’ Hospital, 6th Floor, East Wing, Lambeth Palace Road, London SE1 7EH, UK

Received 31 March 2002; accepted 16 April 2002.

* Corresponding author. Tel.: +44-20-7928-9292x2909; fax: +44-20-7922-8005
e-mail: christopher.blauth{at}gstt.sthames.nhs.uk

Key Words: Mitral valve replacement • Thrombotic pannus • Mitral valve dysfunction

A 67-year-old woman, with a history of two mitral valvotomies, a mechanical mitral valve replacement (MVR) of 13 years and recurrent cardioembolic neurology despite anticoagulation, presented with progressive exertional dyspnoea. Echocardiography revealed mitral stenosis (mean gradient 13 mmHg) and posterior paraprosthetic regurgitation. At operation, a P3 paravalvular leak (Fig. 1) was found, and a culture-negative Carbomedics MVR (Sulzer Medical, Crawley, UK) heavily covered with obstructive pannus was removed (Fig. 2) . A Mosaic bioprosthesis (Medtronic, Tolochenaz, Switzerland) was inserted, and the patient recovered well postoperatively.



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  		Fig. 1. Left atriotomy showing thrombotic pannus overlying Carbomedics mitral valve. Site of paravalvular leak is indicated (white arrow).

 


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  		Fig. 2. Excised pannus and explanted valve.

 




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