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J Thorac Cardiovasc Surg 2004;127:1851
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Obstruction of St Jude Medical valves in the aortic position

Frank A. Baciewicz, Jr, MDa

a Department of Cardiothoracic Surgery, Harper Hospital, Wayne State University, Detroit, MI 48201, USA

To the Editor:

I enjoyed the recent article by Teshima and coworkers, "Obstruction of St Jude Medical Valves in the Aortic Position: Histology and Immunohistochemistry of Pannus" (J Thorac Cardiovasc Surg. 2003;126:401-7). I recently reoperated on 2 young female patients with dysfunction of St Jude Medical prosthetic valves (St Jude Medical, Inc, St Paul, Minn) in the aortic position. Both patients had moderate amounts of pannus formation on the valve. Both patients had significant periods during their postoperative management when anticoagulation was discontinued or inadequate. Perhaps more significantly, they had small aortic roots. The explanted St Jude Medical valves were 19 mm in both patients.

Are young female patients who receive 19- or 21-mm implants for small aortic roots predisposed toward pannus formation? Is pannus formation detected only in 19- and 21-mm valves, in which a minor reduction in orifice area may result in clinically apparent hemodynamic deterioration? I noticed the female predilection in the published series and wondered about the size of the explanted prostheses and if the postimplantation coagulation history of these patients was known.


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Reply to the Editor
Hideki Teshima, Nobuhiko Hayashida, and Shigeaki Aoyagi
J. Thorac. Cardiovasc. Surg. 2004 127: 1851-1852. [Extract] [Full Text] [PDF]




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