[HSF] Pannus Formation

[Nasser F. Abou'Seada]

Dear Hal 
I would be very reluctant to ascribe pannus formation for poor
anticoagulation as a prime variable ..... frank clotting would have been the
result then .... also ... Pannus is formed on the UNDER SURFACE of the valve
.... ventricular surface of a mitral prosthesis ... and Aortic Prosthesis
.... whereas clots are usually starting on the other valve surface -atrial
surface of a mitral prosthesis .... and aortic surface of an aortic
prosthesis  !!! - ... 
In the combined cases that I've seen, pannus has always been there on the
Ventricular surface of the Aortic prosthesis ..... with / without clot
formation on the atrial surface of the mitral prosthesis .... pannus
formation on the ventricular surface of the mitral prosthesis has been
observed as well ....... 

NFA

> From: hgrmd at aol.com
> Bob,
>   I've never heard a good explanation for the cause of pannus.  Is the
majority of it
> due to poor anticoagulation?  I recall having had to explant a few porcine
mitrals that
> had subvalvular pannus around the struts causing stenosis.  Obviously,
none of these
> were on coumadin.  Should they have been?  I would agree with your general
> recommendation to "start over".  However, I also understand Prasanna's
approach
> given the different financial conditions under which he operates.
> Hal
> 
> 
> -----Original Message-----
> From: Rwmfglycar at aol.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Mon, 16 Oct 2006 1:33 AM
> Subject: Re: [HSF] redo double valve
> 
> 
> For whatever reason I saw very few absolutely pure pannus cases. If the
> pannus is the consequence of poorly controlled AC with thrombus, fibrous
> organisation of thrombus, further thrombus etc. then it is obviously
better to
> start
> all over again with an absolutely bare valve or even switch to  a
> bioprosthesis in some cases. Another problem is that patients who are
> unreliable about AC
> are also those who are unreliable about follow up so one  never is quite
sure
> whether the choice one made had a good outcome or not.
> Bobhn
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