Acquired and Reversible von Willebrand Disease With High Shear Stress Aortic Valve Stenosis Kazunori Yoshida, MD, Satoshi Tobe, MD, Masahito Kawata,

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Acquired and Reversible von Willebrand Disease With High Shear Stress Aortic Valve Stenosis Kazunori Yoshida, MD, Satoshi Tobe, MD, Masahito Kawata, MD, Masahiro Yamaguchi, MD The Annals of Thoracic Surgery Volume 81, Issue 2, Pages 490-494 (February 2006) DOI: 10.1016/j.athoracsur.2005.07.074 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Shear stress before (Pre) and 1 month after (Post) surgery. The Annals of Thoracic Surgery 2006 81, 490-494DOI: (10.1016/j.athoracsur.2005.07.074) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Inverse correlation between von Willebrand factor levels and wall shear stress (r2 = 0.391; p < 0.01). The Annals of Thoracic Surgery 2006 81, 490-494DOI: (10.1016/j.athoracsur.2005.07.074) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Von Willebrand factor levels before (Pre) and 1 month after (Post) surgery. The Annals of Thoracic Surgery 2006 81, 490-494DOI: (10.1016/j.athoracsur.2005.07.074) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Correlation between von Willebrand factor and indexed effective orifice area (EOA/BSA; r2 = 0.216; p = 0.02). The Annals of Thoracic Surgery 2006 81, 490-494DOI: (10.1016/j.athoracsur.2005.07.074) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Preoperative immunoblotting analysis. Electrophoresis of human von Willebrand factor typically yields 15 bands, reflecting the range of multimers (S, M, and L indicate small, middle, and large multimers, respectively). Small multimers are represented by the bottom to fifth bands, whereas large multimers are presented by the 11th to 15th bands. The black arrow indicates a deficit of large multimers (L zone). Acquired type IIA von Willebrand disease is characterized by loss of the large von Willebrand factor multimers (L zone). (SS = shear stress.) The Annals of Thoracic Surgery 2006 81, 490-494DOI: (10.1016/j.athoracsur.2005.07.074) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Postoperative immunoblotting analysis. Normalization of large von Willebrand factor multimers occurred in patients without patient–prosthesis mismatch but not in patients with patient–prosthesis mismatch (S, M, and L indicate small, middle, and large multimers, respectively). Panels A, C, and D represent the postoperative electrophoresis of the patients without patient–prosthesis mismatch. Panels B and E represent the postoperative electrophoresis of those with patient–prosthesis mismatch. (SS = shear stress.) The Annals of Thoracic Surgery 2006 81, 490-494DOI: (10.1016/j.athoracsur.2005.07.074) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions