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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2007 February;20(1):25-8
Prosthetic valve thrombosis in the aortic position. Consideration of a possible pathogenic mechanism
Aoyagi S., Fukunaga S., Tayama E., Hori H., Yoshikawa K.
Department of Surgery Kurume University School of Medicine, Kurume, Japan
We report 3 cases of replacement of an aortic St. Jude Medical (SJM) valve with restricted leaflet movement caused by overgrown pannus. In Patient 1, restriction of leaflet opening occurred first, and this restriction progressed finally to complete arrest of one leaflet. During reoperation, overgrown pannus that involved the straight edges of the leaflets was found, along with thrombi in the pivot systems. In Patient 2, restricted leaflet movement with obstruction in the aortic SJM valve gradually progressed on serial cineradiograms over the course of 1 year, despite adequate anticoagulation. At reoperation, pannus overgrowth involving the straight edges of the leaflets was found responsible for the prosthetic valve obstruction. No thrombi were observed in this patient. In addition to periprosthetic leakage, Patient 3 showed mild restriction of leaflet movement in the aortic SJM valve, nevertheless, pannus overgrowth that involved the straight edges of the leaflets was confirmed at reoperation. Anticoagulant therapy was adequate in all patients. Based on these results, the primary etiology of the prosthetic valve obstruction that is generally defined clinically as “prosthetic valve thrombosis” appears to be pannus overgrowth involving the straight edge of the leaflet, followed in the second stage by blockage of leaflet movement through thrombus formation due to poor washout of blood elements in the pivot systems of the SJM valve. Although this mechanism may not necessarily apply to all cases of “prosthetic valve thrombosis”, it may be responsible for some cases with adequate anticoagulation.