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Figure 1: It was almost impossible to remove the pannus completely by forceps and an open tipped suction, so we used a hook to reach the area beneath the leaflets. The pannus was separated from the inferior border of the ring of the mechanical valve prosthesis. The hook is a surgical instrument with a curved tip used to catch, drag, suspend or fasten something, most frequently the suture material (arrow). Figure 2: After the pannus was separated from the prosthesis, it was grasped by the help of forceps and cut by a scalpel and removed.

How to remove subannular pannus formation beneath the prosthetic valve