A Case Report of Reoperation for Björk-Shiley Mechanical Valve 38 Years after Mitral Replacement / 日本心臓血管外科学会雑誌

The patient was a 68-year-old woman who had undergone initial mitral repair at 24 years of age, and had undergone mitral replacement using the Björk-Shiley convexo-concave valve at 30 years of age. She developed exertional dyspnea 38 years after mitral replacement with hemolytic anemia. Precise examination revealed mitral stenosis and perivalvular leak. At the reoperation, severe calcified pannus was found at the ventricular side just beneath the mitral artificial valve, and made stenosis with the inadequate leaflet opening. The mitral valve remnant ring was severely calcified and the sawing ring was detached partially. Repeated valve replacement was successfully done by the reinforcement of the mitral valve ring with xenopericardium.

A Case of Redo-Aortic Valve Replacement for a Lillehei-Kaster Valve Implanted 42 Years Ago / 日本心臓血管外科学会雑誌

We present a case of redo aortic valve replacement (AVR) in a 71-year-old man with a Lillehei-Kaster valve implanted 42 years prior. The patient initially underwent AVR and open mitral commissurotomy procedures for aortic regurgitation complicated with mitral stenosis in 1978 at the age of 29. Thereafter, he was followed at our outpatient clinic and treated without anticoagulant therapy for the initial two decades of the postoperative period. During the long-term follow-up, the mean pressure gradient remained between 40 and 60 mmHg and there were no adverse events noted before occurrence of heart failure triggered by tachycardia and pneumonia. Following improvement of heart failure, redo AVR was performed. There was no structural damage, thrombosis, or Lillehei-Kaster valve opening restrictions, though severe pannus growth on the left ventricle side was observed, which was thought to be the cause of the increased pressure gradient. This is the first known report of redo AVR after many years in a patient who underwent Lillehei-Kaster valve implantation. Furthermore, no other study has noted findings regarding pressure gradient change during the long-term follow-up period in such cases.

A Case of Aortic Valve Re-replacement for Starr-Edwards Ball Valve 45 Years after Implantation / 日本心臓血管外科学会雑誌

This patient is a 72-year-old-man who had undergone aortic valve replacement using a Starr-Edwards Ball Valve to treat aortic valve stenosis when he was 28 years old. In April 2015, he was admitted with cardiac failure of NYHA III. Echocardiography showed a remarkable increase of aortic valve pressure gradient and progressive change in mitral valve stenosis and tricuspid valve regurgitation. The Starr-Edwards Ball Valve was replaced using a CEP MAGNA EASE prosthesis, the mitral valve was replaced using a CEP MAGNA MITRAL EASE prosthesis with tricuspid annuloplasty using the MC3 ring. Cloth wear of the Starr-Edwards Ball Valve cage and all-round pannus formation under the valve seat was found at the operation, and the cause of the higher pressure gradient may have been the pannus. The postoperative period of this case following the initial aortic valve implantation of the Starr-Edwards Ball Valve is the longest known in Japan as far as we could discover.

Research progress of vascular endothelial growth factor in the pathogenesis of rheumatoid arthritis / 中国医师进修杂志

Essential of rheumatoid arthritis (RA) is destruction of invasive pannus formation in cartilage, bone and surrounding tissues Chronic inflammation of synovial membrane. Vascular endothelial growth Factor (VEGF) increases vascular permeability and induces angiogenesis. It plays a very important role in the process of joint erosion and destruction of RA. It not only promotes the formation of RA synovial pannus formation, but also acts as a direct proinflammatory factor in the pathogenesis of RA.

A Case of Prosthetic Valve Dysfunction in the Aortic Position: Caused by Pannus Formation

Prosthetic valve dysfunction caused by pannus formation is an infrequent but serious complication of heart valve replacement. Although the precise mechanisms of the pannus formation are not clearly understood, it is considered to be the result of a bioreaction to the mechanical prosthesis. Prosthetic valve design, surgical techniques, infection, and inadequate anticoagulation also contribute to the pannus formation. In this report, we present one patients who had undergone aortic valve replacement(AVR) with the 20-mm Medtronic Hall prosthetic valve and underwent repeated AVR due to pannus ingrowth in the late postoperative period.

Atlantoaxial Subluxation due to Psoriatic Arthritis

Atlantoaxial subluxation causing spinal cord compression at the craniovertebral junction may develop in patients with rheumatoid or psoriatic arthritis. There have been only a few reports of atlantoaxial subluxation in patients with psoriatic arthritis in the world. The authors report a case of psoriatic arthritis with atlantoaxial subluxation accompaning periodontoid pannus formation. This 53-year-old man with a 3-year history of psoriatic skin lesion presented with nuchal pain and myelopathy. We performed decompression by C1 total laminectomy with transarticular screw fixation and obtained remarkable improvement in motor function and immediate postoperative stability.