1. Pathologic Evaluation of 28 Mitroflow Pericardial Valves: A 12-Year Experience 
Adriana Luk, MD, Robert J. Cusimano, MD, Jagdish Butany, MBBS, MS 
The Annals of Thoracic Surgery 
Volume 99, Issue 1, Pages (January 2015)
DOI: /j.athoracsur
Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
A 21-mm valve explanted from an 80-year-old implanted for 84 months. (A) In this view, thrombus can be seen along one cusp (arrow). There is leaflet thickening along the free margin of the leaflets. Note the high takeoff of the right coronary ostium (arrowhead). (B) A type I tear is seen at the parastent region (arrowhead), along with a separate tear further down the stent post (arrow), likely secondary to abrasion injury. (C) Along the stent post, there is squeezing of the pericardial tissue between the cross-stitches on the stent post. A tear can be seen at the stent post from cutting of the pericardial tissue at its tip.
The Annals of Thoracic Surgery  , 48-54DOI: ( /j.athoracsur )
Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
A 23-mm valve explanted from an 81-year-old woman implanted for 30 months. On the (A) nonflow and (B) flow surfaces, three grade 1 tears located on the parastent regions are seen (arrows), leading to cusp prolapse. Nodular calcification is also seen along the body of the cusps (arrowheads). (C) Calcification (asterisk) can be seen within the valve tissue (Movat-pentachrome stain; magnification × 5). In (D), calcification (asterisk) can be seen on sides of both cusps (P) along the stent post (Movat-pentachrome stain; magnification × 5).
The Annals of Thoracic Surgery  , 48-54DOI: ( /j.athoracsur )
Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
A 21-mm valve explanted from a 68-year-old woman implanted for 102 months. Pannus can be seen on the nonflow surface along the sewing ring with extension onto the base of the leaflets and to the tip of the stent post, as well as the free edge of the leaflets (arrows). Cusp tears are seen at the other stent posts (arrowheads). Significant nodular calcification is seen on both sides of the cusps (asterisk).
The Annals of Thoracic Surgery  , 48-54DOI: ( /j.athoracsur )
Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions