PANNUS TISSUE Growth definition

[ALCapshaw2]

The recent thread entitled "from RobThatsMe" in the Pre-Surgery Forum detailing his upcoming Aortic Valve Replacement because of Pannus Tissue Growth inspired me to do a Google Search for the word Pannus. The following are only 2 of the several web-based links that came up under "pannus definition".

From Google Search for Pannus definition

* Pannus is a medical term for a hanging flap of tissue. When involving the abdomen, it is called a panniculus and consists of skin, fat, and sometimes contents of the internal abdomen as part of a hernia. A pannus can be the result of loose hanging tissues after pregnancy or weight loss. ... (Wikipedia)
(I included this definition because it's vivid mental image is a helpful supplement to the following definition related to Heart Valves.)

* Fibrotic tissue which grows around a newly implanted prosthetic heart valve. Vigorous growth of this healing tissue can freeze or obstruct a replacement valve. Pannus formation may be related, in part, to the design or materials of the prosthesis, or to the degree of anticaoglation (sic-sp).
www.hsforum.com/stories/storyReader$1498
(Note: The comment about "degree of anticoagulation" is confusing to me since it is my understanding that Pannus Tissue Growth can affect both Mechanical and Tissue Valves.)

'AL Capshaw'

 

[dick0236]

* Fibrotic tissue which grows around a newly implanted prosthetic heart valve. Vigorous growth of this healing tissue can freeze or obstruct a replacement valve. Pannus formation may be related, in part, to the design or materials of the prosthesis, or to the degree of anticaoglation (sic-sp).

Thanks Al, this is something that has been in the back of my mind since I read about it a few times on this forum. It's nice too know it is something I probably don't have to worry about.

 

[nngbwh]

Thanks for the info.

 

[Lily]

Interesting, I researched pannus yesterday also. The anti-coagulation info you mentioned (something that I found too) was related to being under-anti-coagulated with mechanical valves (and I thought it was in regard to when the valve was newly-implanted -- but am not certain). I read that both types of valves can develop pannus around the sewing rings but mechanical valves are more prone to acute pannus.

I'm flying low this morning and don't have anymore time for details but would be happy to post some of the links I found, if anyone is interested. Mostly, I was trying to find causes of pannus.

 

[ShezaGirlie]

10 years and bingo..!

10 years and bingo..!

I find it interesting that Robthatsme and another member both had their St. Jude valves for about 10 years and all of a sudden pannus became an issue, so it must not only be possible with newly implanted valves but valves that have been installed for years.

This is interesting...since I've got a 10 year old St. Jude valve and will be watching this thread for more information.

The pannus issue gives rise to the fact that the On-X may be the superior valve when it comes to pannus growth and degree of anticoagulation.

 

[ShezaGirlie]

From the Journal of Thoracic and Cardiovascular Surgery

From the Journal of Thoracic and Cardiovascular Surgery

A SJM valve explanted 196 months after surgery from the same patient shown in Fig 2. A, Outflow aspect. Pannus formation is seen on the inflow side of the housing. B, Inflow aspect. Excess pannus growth involving the ends of the straight edge of the leaflet over the housing and pivot guards.

Link: http://jtcs.ctsnetjournals.org/cgi/content/full/120/1/142

 

[Duffey]

I don't like pannus formation.:mad2:

 

[njean]

According to my doctors in Houston, pannus growth is what is encroaching on the mitral valve that I had implanted in 1975 & has brought on the pulmonary hypertension, BP issues, A-fib, & CHF. This was also the reason that I had to have my old aortic valve swapped out in 2006 which was also implanted in 1975.

For newbies that are viewing this: do not agonize or wonder if this will happen to you......these cases are isolated & definitely NOT the norm! Many, many patients will way outlive their valves (mechanical)!

 

[RobThatsMe]

Hi,

Thought I would share a little more information on this, from my personal standpoint.

My surgeon told me that with mine, as far along as it is, I had to be careful not to elevate my blood pressure for fear that 2 things could happen. ( fyi - normal opening for my type of valve is 1.8 cm, due to the pannus it is now 0.4 cm and closing.)

1. The pannus tissue could get forced up into my valve, catch and lock the liflits open.
2. The pannus tissue could get forced up into my valve, get pinched as the liflets close, and result in it staying locked in the closed position.

Either case is not a good one. Especially the 2nd one!


I should also mention that, as most of you may be aware, not all people with mechanical valves develop pannus. Ther are many out there with mechanical valves that have got a lot more than 10 years out of them. Also, Pannus can develop on any type of heart valve, mechanical or tissue.



So, I am counting the days until I get this fixed.

Great thread Al

Rob

 

[Mileena46]

Thank you Jean! Was starting to freak out a bit there!!

Mileena

 

[Eva]

Thanks Al for the information, and thanks Norma for the comforting news. I feel fragile and senstive and this is scary to me today!!

and

Good luck Rob, hoping all goes well with you. Will try to keep my BP normal.

 

[Lily]

Hope this is helpful

Hope this is helpful

The subject scares me too and the more I read yesterday the more I wondered if pannus could be why my valve is having issues. My annual is next week so I'll ask the cardio about that also.

Member, Arlyss, has written quite a bit on this subject, as well as valvular strands, here on the site; she has posted many links also. It's well worth the site search.

I was doing the research yesterday to see if I could find anything about Rob's possible suture issue.

[edit - could not again find silzone suture info I thought I read -- probably mis-remembered -- so deleted this sentence.]

Somewhere I thought that I read that proper anti-coagulation (as in NOT being under-coagulated; which made me wonder too if this is why some people with tissue valves are first at higher doses of aspirin early post-op and then can reduce it and I was on ACT for the first three post-op months) early on following valve replacement was important.

Here's some of what I found yesterday with my brief notes, in the order that I found it and I'm afraid I don't have time to put it in a better order:

http://asianannals.ctsnetjournals.org/cgi/content/full/13/4/396

79 year old who developed pannus on her 21 year old CE porcine tissue valve

http://www.wellsphere.com/heart-hea...lves-what-is-the-clinical-significance/629218

pannus vs. thrombus

http://www.medhelp.org/posts/Heart-Disease/Aortic-valve-and-pannus-formation/show/251271

This medhelp link was succinct and interesting, with an inquiry and a series of questions and a reply from a CCF cardio; and there is another related inquiry with more questions and a reply linked.

http://cat.inist.fr/?aModele=afficheN&cpsidt=1581260

Differentiating between thrombus (which has options for non-surgical therapy) and pannus

http://www.springerlink.com/content/8386666k1450582n/

Abstract
Pannus formation after aortic valve replacement is not common, but obstruction due to chronic pannus is one of the most serious complications of valve replacement. The causes of pannus formation are still unknown and effective preventive methods have not been fully elucidated. We reviewed our clinical experience of all patients who underwent reoperation for prosthetic aortic valve obstruction due to pannus formation between 1973 and 2004. We compared the initial 18-year period of surgery, when the Björk–Shiley tilting-disk valve was used, and the subsequent 13-year period of surgery, when the St. Jude Medical valve was used. Seven of a total of 390 patients (1.8%) required reoperation for prosthetic aortic valve obstruction due to pannus formation. All seven patients were women; four patients underwent resection of the pannus and three patients needed replacement of the valve. The frequency of pannus formation in the early group was 2.4% (6/253), whereas it was 0.73% (1/137) in the late group (P < 0.05). Pannus was localized at the minor orifice of the Björk–Shiley valve in the early group and turbulent transvalvular blood flow was considered to be one of the important factors triggering its growth. We also consider that small bileaflet valves have the possibility of promoting pannus formation and that the implantation of a larger prosthesis can contribute to reducing the occurrence of pannus.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742797/pdf/v079p00480.pdf

Pannus common with both valves; acute pannus seen more often with mechanical valves

 

[barbwil]

I had never heard of pannus before Andy spoke of it and it just got me to wondering----do you know if it's possible for it to happen on the Cosgrove ring that is used for a mitral valve repair?

 

[ShezaGirlie]

I was doing the research yesterday to see if I could find anything about Rob's possible suture issue. There was one thing I found, that I evidently didn't copy the link to, that I think was about an issue with silzone-coated suture material -- if I am remembering it correctly.

The silzone coating is on the sewing cuff of the St. Jude Silzone valve and it was approved by the FDA as a modification of the St. Jude valve to protect against bacterial endocarditis. There was a higher than acceptable instance of problems with the silzone coating, so those valves were recalled off the shelf in early 2000. Seems thrombus was the issue instead of pannus, but who knows?!?!?!

At any rate, pannus growth is not something anyone should lose sleep over as the percentages Lily quoted with problems is very, very small - in some cases less than 1%. I've got a #23 aortic valve and that's a pretty big one..:biggrin2:, so I was glad to read that "bigger is better"..:thumbup:

 

[NewValveNY]

Hi all, was looking up pannus growth on mechanical valve and found this article. It seems that while it is not common, it does happen, and there is a solid approach to "cleaning up" the scar tissue or replacing the valve. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631909/

 

[mom2angel]

Very interesting. Going to read this all after Thanksgiving travels. Dealing with a similar issue with my 24 year old St. Judes mitral valve. After 24 years, I am having symptoms of a failing valve. Doctors want to replace it instead of looking into options of saving it. They do not know why it is "failing." They claim they are expecting to find tissue growing on it when they get in there to take it out. They are using the "open you up and then see what is in there" approach. Best of luck to everyone.