Excessive pannus overgrowth on the aortic side of Trifecta valve determining severe regurgitation.

Structural valve deterioration represents the most important concern regarding the implantation of a biological heart valve in young patients. Several strategies have been proposed to improve prosthesis design in order to optimize performance and durability. Here we describe an early and specific mode for valve degeneration of prosthesis with outwards mounted pericardial leaflets due to pannus overgrowth on the aortic side. This led to leaflet retraction in two consecutive cases four and six years after the first implantation of a Trifecta valve.