CTICasesMechanical Mitral Valve Pannus
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Imaging findings
A gated CT angiogram performed for pre-operative evaluation of a 1987-placed mechanical bileaflet Saint Jude valve showed reduced leaflet motion of both leaflets. The leaflets were not opening to their normal parallel position, suggesting fixation or restricted motion. A subtle 'street art effect' indicated possible pannus formation along the under-surfaces of both leaflets, restricting their movement. Echo had previously identified severe stenosis across the valve, initially thought to be patient-prosthesis mismatch due to an aneurysm.
Key takeaways
The patient presented with significant dyspnea. Surgical replacement of the valve and aorta confirmed extensive pannus in-growth underneath the valve. In the acute setting, thrombus or vegetation would be in the differential, but this represented a chronic, indolent process causing progressive worsening of valve function. CT angiography can be a useful tool to visualize mechanical valve leaflet motion and identify pannus.
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