Perivalvular pannus and valve thrombosis: Two concurrent mechanisms of mechanical valve prosthesis dysfunction

• Main Authors: María Elena Arnáiz-García, Jose María González-Santos, María E. Bueno-Codoñer, Javier López-Rodríguez, María José Dalmau-Sorlí, Adolfo Arévalo-Abascal, Antonio Arribas-Jiménez, Alejandro Diego-Nieto, Javier Rodríguez-Collado, Jose María Rodríguez-López
• Format: Article
• Language: English
• Published: Elsevier 2015-02-01
• Series: Revista Portuguesa de Cardiologia
• Online Access: http://www.sciencedirect.com/science/article/pii/S0870255115000104

A 78-year-old woman was admitted to our institution with progressive dyspnea. She had previously been diagnosed with rheumatic heart disease and had undergone cardiac surgery for mechanical mitral valve replacement ten years previously. Transesophageal echocardiography revealed blockage of the mechanical prosthesis and the patient was scheduled for surgery, in which a thrombus was removed from the left atrial appendage. A partial thrombosis of the mechanical prosthesis and circumferential pannus overgrowth were concomitantly detected. Prosthetic heart valve blockage is a rare but life-threatening complication, the main causes of which are thrombosis and pannus formation. The two conditions are different but both are usually misdiagnosed. Two concurrent mechanisms of prosthesis blockage were found in this patient. Resumo: Uma mulher de 78 anos de idade, foi admitida na nossa instituição com dispneia progressiva. Foi-lhe previamente diagnosticada doença reumática, tendo sido submetida a cirurgia cardíaca de substituição de válvula mitral por prótese mecânica há dez anos. O ecocardiograma transesofágico revelou um bloqueio da prótese mecânica. A paciente foi referida para a cirurgia, tendo sido removido um trombo do apêndice atrial esquerdo. A trombose parcial de prótese mecânica e o crescimento circunferencial de pannus ocorreram concomitantemente. O bloqueio das válvulas cardíacas protésicas é uma complicação rara mas potencialmente fatal. As principais causas são a trombose ou formação de pannus. As duas condições são diferentes, mas em regra erradamente diagnosticadas. Nesta paciente foi detetado um duplo mecanismo de bloqueio de prótese. Keywords: Mitral, Prosthesis, Thrombosis, Pannus, Mechanical valve dysfunction, Palavras-chave: Mitral, Prótese, Trombose, Pannus, Disfunção valvar mecânica