# A particular appearance of a diaphragm pannus completely masking a mechanical mitral valve: a case report

## TL;DR

A 58-year-old man had a rare case where a diaphragm pannus completely covered his mechanical mitral valve, requiring urgent surgery to restore normal function.

## Contribution

This case report highlights the rare occurrence of a diaphragmatic pannus masking a mitral mechanical valve and its surgical resolution.

## Key findings

- A diaphragmatic pannus completely masked a mechanical mitral valve, causing acute dyspnea and poor hemodynamics.
- Redo surgery successfully removed the pannus and restored normal leaflet motion of the prosthetic valve.
- The pannus developed at the mitral valve rather than the aortic valve, which is uncommon.

## Abstract

In this article, we report the case of a 58-year-old man who was admitted to our institution with acute dyspnea and poor hemodynamic condition. He had undergone double mitral-aortic valve replacement five years earlier for rheumatic heart disease. Transthoracic echocardiography (TTE), cinefluoroscopy, and transesophageal echocardiography (TEE) revealed a significant reduction in the opening of the mechanical mitral valve leaflets. An urgent redo surgery was performed, during which the pannus was removed, ensuring the restoration of normal leaflet motion. This clinical case presents two rare circumstances: first, the unusual diaphragmatic pannus completely masking the mechanical mitral prosthetic valve, and second, the development of pannus at the level of the mitral mechanical prosthesis rather than the aortic mechanical prosthesis.