Usefulness of computed tomography scanning in the diagnosis of aortic prosthetic valve pannus.

A 64-year old patient underwent aortic valve replacement with a bileaflet Medtronic Advantage prosthesis. Six years later, she presented with a recurrence of symptoms, at which time Doppler echocardiography revealed an obstruction of the aortic mechanical prosthesis (mean transvalvular gradient 35 mmHg). Both, transesophageal echocardiography and fluoroscopy failed to identify the mechanism of valve obstruction. Multislice computed tomography (CT) scanning provided indirect signs as well as direct evidence of pannus formation, which was confirmed at surgery. The value of CT scanning to assess the mechanism of aortic mechanical prosthesis obstruction is emphasized.