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Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
The growth of host tissue on the stents is expected and is, to some extent, part of the normal healing reaction to prosthesis implantation. Pannus has both beneficial and harmful effects, in that a small amount of tissue growth over the suture line is needed for forming a nonthrombogenic surface and for the healing process to be completed. Extension of pannus onto the adjacent portions of the cusps is an exuberant reaction, which, in the longer term, can be a cause of bioprosthetic valve failure (Fig. 3.85).17 Increased pannus can extend onto the cusp surfaces and lead to thickening of the cusps, increasing its stiffness and thereby affecting its ability to open fully, ultimately resulting in stenosis and thrombosis (seeFig. 3.85) (Fig. 3.91). In addition, this pannus itself can become calcified and lead to further valve dysfunction.
Atlantoaxial Subluxation in Rheumatoid Arthritis
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
This patient describes symptoms of myelopathy and has cervical parameters which are concerning for cord compression. I would like to obtain a CT to assess bony changes and an MRI scan to evaluate pannus formation. The indications for surgical intervention in the rheumatoid neck are intractable pain, neurologic dysfunction, subaxial subluxation and atlanto-axial subluxation greater than 8mm. If the preceding investigations and examination were suggestive of cord compression/myelopathy, I would offer the patient surgery. Patients with neurological deficit should be offered surgery given the high mortality with non-operative management.
Artificial Valves
Published in Takahiro Shiota, 3D Echocardiography, 2020
Giovanni La Canna, Iside Scarfò, Philippe Pibarot
Pannus might also be an obstruction mechanism in biological prostheses.19Figure 15.11 reports a case of biological prosthesis obstruction due to an intrastent pannus that was visualized using an off-axis deep esophageal 2D TEE view (“transcardia view”) permitting a complete cross section of the prosthesis. Intrastent pannus findings were visualized with 3D TEE, and the residual intrastent area was calculated using 2D imaging guided by multiview analysis. The pannus findings were confirmed during subsequent surgery performed because of symptoms occurrence and severe pulmonary artery hypertension (sPAP 90 mm Hg) during stress exercise echocardiography.
The INSPIRIS RESILIA Aortic Valve: From Bench to Bedside
Published in Structural Heart, 2020
Bart Meuris, Michel Aupart, Filip Rega, Quentin Langouet, Peter Verbrugghe, Thierry Bourguignon
Results: A) Preclinical sheep data: In total, 33 animals survived the whole 8-month implantation period uneventfully (6 peri-operative deaths and 4 lost due to endocarditis). The echocardiography at 8 months showed normal hemodynamic behaviour (mean gradient 4.9 ± 0.5mmHg). At autopsy, we found no major abnormalities. Histology showed no tissue failure and low pannus formation. The low calcium score on X-ray was confirmed by low calcium content values (2.4 ± 0.5 µg/mg tissue). B) Clinical data: The in-hospital mortality was 1.2% (n=3). The mean follow-up is now 12 months in this patient cohort. No major valve-related early events were observed: no early failure, thrombosis or degeneration. At discharge, we saw echo data: peak and mean gradient: 18 and 11 mmHg respectively, EOA 2.1cm2.
Increased expression of the proprotein convertase enzyme FURIN in rheumatoid arthritis
Published in Scandinavian Journal of Rheumatology, 2019
A Valli, N Ranta, A Grönholm, O Silvennoinen, M Pesu, P Isomäki
The expression of FURIN in RA has not previously been systematically studied, and no data are available regarding FURIN expression in leucocytes from RA patients. Lin et al (12) reported upregulated expression of FURIN in synovial pannus derived from three patients with RA. In addition to RA, FURIN has been found to be upregulated in PBMCs and salivary gland biopsies in primary Sjögren’s syndrome (9, 10). Elevated FURIN levels have also been seen in patients with systemic lupus erythematosus (13). Together, these previous results and our current findings showing increased FURIN expression in RA indicate that FURIN is upregulated in different types of rheumatic disease.
Bionanocellulose as a Potential New Matrix Material for Heart Valve Construction
Published in Structural Heart, 2020
Katrien Vandendriessche, Piotr Siondalski, Magdalena Kolaczkowska, Filip Rega, Peter Verbrugghe, Maciej Kowalik, Bart Meuris
Conclusions: Prosthetic valves made from bionanocellulose in pulmonary position demonstrated adequate long-term function with minimal regurgitation. The valves displayed sustained mechanical integrity. There was tissue overgrowth without excessive pannus formation. There was no calcification of the material itself, and only minimal calcification was seen extrinsic to the matrix. These results, together with earlier experimental data, indicate the potential of this material for fabrication of heart prostheses. Further testing is necessary in high-pressure environments and/or with alternative designs of the valve.