Letter To The Editor
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2015; 7(11): 822-823
Published online Nov 26, 2015. doi: 10.4330/wjc.v7.i11.822
Imaging of pannus formation in patients with mechanical heart valves
Sabahattin Gündüz, Mehmet Özkan, Mahmut Yesin
Sabahattin Gündüz, Mehmet Özkan, Mahmut Yesin, Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, 34846 İstanbul, Turkey
Author contributions: All the authors equally contributed to this work.
Conflict-of-interest statement: None of the authors have any conflict of interest to be disclosed.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sabahattin Gündüz, MD, Cardiologist, Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Denizer Cad. No: 2, Cevizli kavşağı, 34846 İstanbul, Turkey. sabahattingunduz@yahoo.com
Telephone: +90-505-5379809 Fax: +90-216-3682527
Received: May 26, 2015
Peer-review started: May 28, 2015
First decision: July 3, 2015
Revised: July 24, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: November 26, 2015
Processing time: 187 Days and 17.2 Hours
Abstract

Patient-prosthesis mismatch (PPM) should be recognized in patients with elevated transprosthetic gradients but without leaflet immobility, since the treatment strategy may differ in either etiology. However, thrombus and/or pannus formation should be excluded before a diagnosis of PPM is made. Particularly, pannus formation may not be diagnosed with 2-dimensional transesophageal echocardiography. Electrocardiographically gated 64-section multidetector computed tomography (MDCT) may be a promising tool in diagnosing or excluding pannus formation. Our report underlines the utility of MDCT in this regard and also emphasizes the importance of recognition of PPM as a differential diagnosis in such patients.

Keywords: Multidetector computed tomography; Pannus formation; Patient prosthesis mismatch; Prosthetic heart valves; Transesophageal echocardiography

Core tip: Elevated transprosthetic gradients may be caused by pannus and/or thrombus formation or patient prosthesis mismatch (PPM). The differentiation between these three diagnoses is essential since the treatment strategy may differ in either etiology. Our report emphasizes the usefulness of cardiac multidetector computerized tomography in cases with suspected pannus formation which may not be diagnosed without surgical confirmation. Moreover, we underline the importance of recognizing PPM which may easily be overlooked in patients with elevated transprosthetic gradients. Indeed, pannus, trombus or any other masses as the cause of prosthetic dysfunction should be ruled out for a diagnosis of PPM.