Complete Resolution of a Large Bicuspid Aortic Valve Thrombus with Anticoagulation in Primary Antiphospholipid Syndrome

Rachwan, Rayan Jo; Daher, Ghassan; Fares, Jawad; Rachoin, Rachoin

doi:10.3389/fcvm.2017.00059

Cited by 11 publications

(5 citation statements)

References 30 publications

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“…The estimated prevalence of NBTE ranges from 0.3% to 9.3% (2). In patients with APLS, as many as one-third develop cardiac valve disease (3,4). The case reported here represents a rare occurrence of near resolution of NBTE and improvement in mitral valve regurgitation with warfarin therapy, obviating the need for surgical intervention.…”

Section: Giant Thrombus Occupying the Right Cardiac Chambers In A Canmentioning

confidence: 83%

Near Complete Resolution of Nonbacterial Thrombotic Endocarditis in a Patient with Antiphospholipid Antibody Syndrome

et al. 2020

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of hepatocellular carcinoma (HCC). Transesophageal echocardiography from both midesophageal bicaval view (Fig. 1, Panel E, Supplementary Video S2) and four-chamber view (Fig. 1, Panel F) highlighted the highly mobile mass that occupied the right chambers and extended into the PA and therefore, blocked both the RV inflow and outflow tract. However, few hours after admission and despite the attempted rescue thrombolysis, the patient experienced sudden cardiac arrest. HCC patients are known to have an increased risk of thrombosis; however, a giant metastatic thrombus that extends from the IVC to the PA is still considered an unusual presentation of HCC. Informed consent: The informed consent was obtained from the patient. Supplementary Video S1. Transthoracic echocardiography, subcostal view: giant mass occupying the right atrium (RA), protruding into the right ventricle (RV), and significantly obliterating the tricuspid valve. Supplementary Video S2. Transesophageal echocardiography, midesophageal bicaval view revealing highly mobile mass occupying the right chambers.

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Section: Giant Thrombus Occupying the Right Cardiac Chambers In A Canmentioning

confidence: 83%

Near Complete Resolution of Nonbacterial Thrombotic Endocarditis in a Patient with Antiphospholipid Antibody Syndrome

et al. 2020

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“…Anticoagulation therapy has been used for native aortic valve thrombosis in primary antiphospholipid syndrome, and echocardiography showed complete resolution of the aortic valve vegetation after a few months; the patient improved clinically and had no lingering symptoms. [10] It has been suggested that vegetations in antiphospholipid syndrome can be treated successfully with anticoagulation treatment, regardless of their size. [10] The epidemiological practices indicated that in recent years, the incidence of IE has increased, especially in elderly individuals and hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

“…[10] It has been suggested that vegetations in antiphospholipid syndrome can be treated successfully with anticoagulation treatment, regardless of their size. [10] The epidemiological practices indicated that in recent years, the incidence of IE has increased, especially in elderly individuals and hospitalized patients. [11,12] In our case, we think that after the patient was suspected to have multi-organ cardiac embolism, early and integrally repeated echocardiography should have been performed as well as risk factor screening; then after weighing the advantage and disadvantage, anticoagulation therapy should have been considered earlier.…”

Section: Discussionmentioning

confidence: 99%

Multi-organ embolism caused by oscillating aortic valve vegetation

et al. 2019

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Introduction: Valvular vegetation is often due to rheumatic heart disease and infective endocarditis. However, multi-arterial embolism can happen in older patients with no history of infection, fever, and cardiac symptoms. We describe a case of multi-organ embolism caused by oscillating aortal valve vegetation. Patient concerns: An 80-year-old woman without a history of infection, fever, and heart symptoms showed sudden loss of consciousness and symptoms of a multi-vessel embolism. Magnetic resonance imaging revealed multiple patchy ischemic foci in both cerebral hemispheres in the same time-phase, and echocardiography showed regurgitation in the aortic valve due to an abnormally hypo-hyperechoic mass measuring about 7.7 × 17.2 mm and oscillating aortic valve vegetation, which was induced by cardiac contraction. Diagnosis: Multiple organ cardiac embolisms caused by oscillating aortic valve vegetation. Interventions: Anti-platelet, fluid-supplement, and vascular-dilating therapies as well as intravenous diazepam were given to the patient. Outcome: The patient died of epileptic attack secondary to the cerebral embolism. Conclusions: The patient's whole-body multi-vessel ischemic events in nearly the same time-phase should have encouraged us to consider the possibility of cardiogenic embolism and thus early examination and treatment, although she was old with a relatively poor response due to early infection and physical discomfort. Clinicians should be aware that aortic valve vegetation induces generalized multi-organ embolism in the setting of infective endocarditis in order to ensure prompt recognition and treatment of this fatal complication.

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“…The same has been the case for isolated tricuspid valve NBTE associated with APS [ 8 ]. A literature review revealed only scarce reported cases of NBTE presenting as large vegetations in male patients with APS, and those found were restricted to the aortic valve, which is a more common site of NBTE involvement [ 10 ]. We found no published studies addressing gender differences in the prevalence of APS with NBTE.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient was not a candidate for continued medical management due to the severity of his heart failure, as well as an observed lability on warfarin which made it difficult to maintain INR at a therapeutic value. However, recent case reports have shown complete resolution of an aortic valve thrombus with warfarin [ 10 ], as well as resolution of TV NBTE in a patient managed with vitamin K antagonists-hydroxychloroquine (VKA-HCQ) [ 11 ]. Clinical trials are still necessary to further evaluate said treatment options and develop more robust therapies for NBTE in patients with APS.…”

Section: Discussionmentioning

confidence: 99%

Nonbacterial Thrombotic Endocarditis of the Tricuspid Valve in a Male Patient with Antiphospholipid Syndrome

Yordan-Lopez

Hernández-Suárez

Marshall-Perez

et al. 2018

Cureus

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Valve vegetations in nonbacterial thrombotic endocarditis consist of fibrin and platelet aggregates and can be related to circulating immune complexes, such as in the case of antiphospholipid syndrome. In patients with primary antiphospholipid syndrome, echocardiographic studies have disclosed heart valve abnormalities in about a third of patients. Unusual associations between antiphospholipid syndrome and nonbacterial thrombotic endocarditis include presentation as an intracardiac mass compatible with a myxoma on imaging studies, as well as isolated involvement of the tricuspid valve. Both of these scenarios have been previously reported in female patients. This article presents the case of a 53-year-old Hispanic male with antiphospholipid syndrome who presented to the hospital with symptoms of heart failure and persistent right calf pain. An intracardiac mass attached to the anterior leaflet of the tricuspid valve was found through transthoracic echocardiography. Further imaging studies suggested the mass to be a myxoma and the patient underwent mass excision with tricuspid valve replacement. Pathology report of the surgical specimen was consistent with a diagnosis of nonbacterial thrombotic endocarditis. This case highlights the importance of considering nonbacterial thrombotic endocarditis as a key differential diagnosis in patients with concomitant antiphospholipid syndrome and intracardiac masses, as well as challenges encountered in diagnosis and management.

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Complete Resolution of a Large Bicuspid Aortic Valve Thrombus with Anticoagulation in Primary Antiphospholipid Syndrome

Cited by 11 publications

References 30 publications

Near Complete Resolution of Nonbacterial Thrombotic Endocarditis in a Patient with Antiphospholipid Antibody Syndrome

Near Complete Resolution of Nonbacterial Thrombotic Endocarditis in a Patient with Antiphospholipid Antibody Syndrome

Multi-organ embolism caused by oscillating aortic valve vegetation

Nonbacterial Thrombotic Endocarditis of the Tricuspid Valve in a Male Patient with Antiphospholipid Syndrome

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