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Clinical Research in Cardiology

, Volume 107, Issue 7, pp 554–564 | Cite as

Impact of pannus formation on hemodynamic dysfunction of prosthetic aortic valve: pannus extent and its relationship to prosthetic valve motion and degree of stenosis

  • Hyun Jung Koo
  • Hojin Ha
  • Joon-Won Kang
  • Jeong A. Kim
  • Jae-Kwan Song
  • Hwa Jung Kim
  • Tae-Hwan Lim
  • Dong Hyun Yang
Original Paper

Abstract

Background

Although pannus is an important cause of prosthetic valve dysfunction, the minimum pannus size that can induce hemodynamic dysfunction has not yet been determined. This study investigated the correlation between the limitation of motion (LOM) of the prosthetic valve and pannus extent and determined the pannus extent that could induce severe aortic stenosis.

Methods

This study included 49 patients who underwent mechanical aortic valve replacement (AVR) and showed pannus on cardiac computed tomography (CT). Pannus width, ratio of pannus width to valve diameter, pannus area, effective orifice area, encroachment ratio by pannus, pannus involvement angle and percent LOM of mechanical valves were evaluated on CT. Transvalvular peak velocity (TPV) and transvalvular pressure gradient (TPG) were measured by transesophageal echocardiography to determine the degree of aortic stenosis. The relationship between percent LOM of the prosthetic valve and pannus extent and the cut-off of pannus extent required to induce severe aortic stenosis were evaluated.

Results

The mean interval between AVR and pannus formation was 11 years and was longer in patients with than without severe aortic stenosis (14.0 vs. 7.3 years). On CT, the percent LOM of the prosthetic valve was significantly associated with the extent of pannus only in patients with pannus involvement angle > 180° (r = 0.55–0.68, P < 0.01). Pannus width, effective orifice area, and encroachment ratio were significantly associated with increased TPV and TPG (r = 0.51–0.62, P < 0.01). Pannus width > 3.5 mm, pannus width/valve inner diameter > 0.15, and encroachment ratio > 0.14 were significantly associated with severe aortic stenosis (TPV > 4 m/s; mean TPG ≥ 35 mmHg), with c-indices of 0.74–079 (P < 0.005).

Conclusion

CT-derived pannus extent parameters are good indicators of significant hemodynamic changes with increased TPV and mean TPG.

Keywords

Pannus Aortic valve replacement Mechanical valve Computed tomography 

Notes

Acknowledgements

This work was supported by National Research Foundation of Korea (NRF) Grants funded by the Korean government (MSIP) (NRF-2016R1A1A1A05921207 and NRF-2015R1A2A2A04003034) and by a grant (2017–7208) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. This work was also funded by the Industrial Strategic Technology Development Program (10072064) of the Ministry of Trade Industry and Energy of Korea.

Author contributions

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflict of interest.

Supplementary material

392_2018_1217_MOESM1_ESM.docx (401 kb)
Supplementary material 1 (DOCX 401 KB)
392_2018_1217_MOESM2_ESM.xlsx (20 kb)
Supplementary material 2 (XLSX 19 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hyun Jung Koo
    • 1
  • Hojin Ha
    • 2
  • Joon-Won Kang
    • 1
  • Jeong A. Kim
    • 3
  • Jae-Kwan Song
    • 4
  • Hwa Jung Kim
    • 5
  • Tae-Hwan Lim
    • 1
  • Dong Hyun Yang
    • 1
    • 6
  1. 1.Department of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Mechanical and Biomedical EngineeringKangwon National UniversityChuncheonRepublic of Korea
  3. 3.Department of Radiology, Ilsan Paik HospitalInje University College of MedicineGoyangRepublic of Korea
  4. 4.Department of Cardiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.Department of Clinical Epidemiology and Biostatistics, Cancer Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  6. 6.Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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