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Valvular Excrescences: A Possible Transient Phenomenon.

Marstrand P, Jensen MB, Ihlemann N - Case Rep Cardiol (2015)

Bottom Line: A possible locus on the aortic valve was found and diagnosed as fibroelastoma.Before aortic valve substitution prior finding could not be visualized and surgery was aborted.This illustrates the need for TEE just before surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.

ABSTRACT
The thrombogenic potential of Lambl excrescences (LE) is minimal unlike the benign tumour fibroelastoma wherefrom thrombi often originate. We present a patient with multiple strokes within a six-year period. A possible locus on the aortic valve was found and diagnosed as fibroelastoma. Before aortic valve substitution prior finding could not be visualized and surgery was aborted. Due to review of earlier Transesophageal Echocardiography (TEE) and the transient component, LE was accepted as the most plausible diagnosis. This illustrates the need for TEE just before surgery.

No MeSH data available.


Related in: MedlinePlus

A longitudinal TEE still picture of left ventricle outflow track and the aortic valve. (a) The examination, which led to the surgery, is shown. The arrow marks a thin approximately 10 mm long vegetation with classic location and substance equivalent to Lambl excrescence. (b) A TEE performed after the cancellation and the prior finding is not reproducible.
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fig1: A longitudinal TEE still picture of left ventricle outflow track and the aortic valve. (a) The examination, which led to the surgery, is shown. The arrow marks a thin approximately 10 mm long vegetation with classic location and substance equivalent to Lambl excrescence. (b) A TEE performed after the cancellation and the prior finding is not reproducible.

Mentions: A 48-year-old man, predisposed to thromboembolic events by smoking, hypertension, hypercholesterolemia, and family history, debuted in 2008 with 5 CT verified cerebral strokes. The patient was treated with platelet inhibitors, antihypertensive, and cholesterol lowering drugs. Due to side effects, the patient stopped all medication after one year. In 2012 and 2014 the patient suffered from strokes again and had a work-up including testing for infectious focus, coronary angiography, and thrombophilia screening. All were negative. Atheromatosis without significant stenosis was found by ultrasound of the carotid arteries. A Transesophageal Echocardiography (TEE) was performed and a thread-like frond was found on the aortic valve (see Figure 1(a)). The excrescence was interpreted as a fibroelastoma and this was thought to explain the strokes. The patient was therefore planned for surgical valve resection. During the anaesthesia a TEE was performed but now the tumour/excrescence was no longer visible. The surgery was therefore aborted. At a TEE performed 3 weeks later it was still not recognized nor was paradox embolism. After reviewing all the TEE data it was concluded that the most likely diagnosis was Lambl excrescence (see Figure 1(b)).


Valvular Excrescences: A Possible Transient Phenomenon.

Marstrand P, Jensen MB, Ihlemann N - Case Rep Cardiol (2015)

A longitudinal TEE still picture of left ventricle outflow track and the aortic valve. (a) The examination, which led to the surgery, is shown. The arrow marks a thin approximately 10 mm long vegetation with classic location and substance equivalent to Lambl excrescence. (b) A TEE performed after the cancellation and the prior finding is not reproducible.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663329&req=5

fig1: A longitudinal TEE still picture of left ventricle outflow track and the aortic valve. (a) The examination, which led to the surgery, is shown. The arrow marks a thin approximately 10 mm long vegetation with classic location and substance equivalent to Lambl excrescence. (b) A TEE performed after the cancellation and the prior finding is not reproducible.
Mentions: A 48-year-old man, predisposed to thromboembolic events by smoking, hypertension, hypercholesterolemia, and family history, debuted in 2008 with 5 CT verified cerebral strokes. The patient was treated with platelet inhibitors, antihypertensive, and cholesterol lowering drugs. Due to side effects, the patient stopped all medication after one year. In 2012 and 2014 the patient suffered from strokes again and had a work-up including testing for infectious focus, coronary angiography, and thrombophilia screening. All were negative. Atheromatosis without significant stenosis was found by ultrasound of the carotid arteries. A Transesophageal Echocardiography (TEE) was performed and a thread-like frond was found on the aortic valve (see Figure 1(a)). The excrescence was interpreted as a fibroelastoma and this was thought to explain the strokes. The patient was therefore planned for surgical valve resection. During the anaesthesia a TEE was performed but now the tumour/excrescence was no longer visible. The surgery was therefore aborted. At a TEE performed 3 weeks later it was still not recognized nor was paradox embolism. After reviewing all the TEE data it was concluded that the most likely diagnosis was Lambl excrescence (see Figure 1(b)).

Bottom Line: A possible locus on the aortic valve was found and diagnosed as fibroelastoma.Before aortic valve substitution prior finding could not be visualized and surgery was aborted.This illustrates the need for TEE just before surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.

ABSTRACT
The thrombogenic potential of Lambl excrescences (LE) is minimal unlike the benign tumour fibroelastoma wherefrom thrombi often originate. We present a patient with multiple strokes within a six-year period. A possible locus on the aortic valve was found and diagnosed as fibroelastoma. Before aortic valve substitution prior finding could not be visualized and surgery was aborted. Due to review of earlier Transesophageal Echocardiography (TEE) and the transient component, LE was accepted as the most plausible diagnosis. This illustrates the need for TEE just before surgery.

No MeSH data available.


Related in: MedlinePlus