HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Teshima, H. Articles by Aoyagi, S. Search for Related Content PubMed PubMed Citation Articles by Teshima, H. Articles by Aoyagi, S. Related Collections Valve disease

J Thorac Cardiovasc Surg 2003;126:401-407
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Obstruction of St Jude medical valves in the aortic position: histology and immunohistochemistry of pannus

^a From the Departments of Surgery and Pathology, Kurume University, School of Medicine, Kurume, Japan

Received for publication November 12, 2002; revisions received January 21, 2003; revisions received April 1, 2003; accepted for publication April 8, 2003.

^* Address for reprints: Hideki Teshima, MD, Department of Surgery, Kurume University, School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
tesshi{at}med.kurume-u.ac.jp

OBJECTIVE: This study aims to reveal the morphological, histological, and immunohistochemical mechanism of pannus formation using resected pannus tissue from patients with prosthetic valve dysfunction.

METHOD: Eleven patients with prosthetic valve (St Jude Medical valve) dysfunction in the aortic position who underwent reoperation were studied. We used specimens of resected pannus for histological staining (hematoxylin and eosin, Grocott’s, azan, elastica van Gieson) and immunohistochemical staining (transforming growth factor-beta, transforming growth factor-beta receptor 1, -smooth muscle actin, desmin, epithelial membrane antigen, CD34, factor VIII, CD68KP1, matrix metalloproteinase-1, matrix metalloproteinase-3, and matrix metalloproteinase-9).

RESULTS: Pannus without thrombus was observed at the periannulus of the left ventricular septal side; it extended into the pivot guard, interfering with the movement of the straight edge of the leaflet. The histological staining demonstrated that the specimens were mainly constituted with collagen and elastic fibrous tissue accompanied by endothelial cells, chronic inflammatory cells infiltration, and myofibroblasts. The immunohistochemical findings showed significant expression of transforming growth factor-beta, transforming growth factor-beta receptor 1, CD34, and factor VIII in the endothelial cells of the lumen layer; strong transforming growth factor-beta receptor 1, -smooth muscle actin, desmin, and epithelial membrane antigen in the myofibroblasts of the media layer; and transforming growth factor-beta, transforming growth factor-beta receptor 1, and CD68KP1 in macrophages of the stump lesion.

CONCLUSIONS: Pannus appeared to originate in the neointima in the periannulus of the left ventricular septum. The structure of the pannus consisted of myofibroblasts and an extracellular matrix such as collagen fiber. The pannus formation after prosthetic valve replacement may be associated with a process of periannular tissue healing via the expression of transforming growth factor-beta.

Key Words: 35

This article has been cited by other articles:

				M. Kondruweit, F. A. Flachskampf, M. Weyand, J. Schmidt, S. Achenbach, and T. Strecker Early failure of a mechanical bileaflet aortic valve prosthesis due to pannus: A rare complication J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 213 - 214. [Full Text] [PDF]

				E. Konen, O. Goitein, M. S. Feinberg, Y. Eshet, E. Raanani, U. Rimon, and E. Di-Segni The Role of ECG-Gated MDCT in the Evaluation of Aortic and Mitral Mechanical Valves: Initial Experience Am. J. Roentgenol., July 1, 2008; 191(1): 26 - 31. [Abstract] [Full Text] [PDF]

				D. D. Potter, T. M. Sundt III, K. J. Zehr, J. A. Dearani, R. C. Daly, C. J. Mullany, C. G.A. McGregor, F. J. Puga, H. V. Schaff, and T. A. Orszulak Operative risk of reoperative aortic valve replacement J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 94 - 103. [Abstract] [Full Text] [PDF]