Lambl’s Excrescence as an Etiology of Thromboembolism: Case Report and Literature Review

Abstract

Lambl’s excrescence (LE), a rare thin linear fibrous thread of collagen and elastic fibrous tissue originating at closure margins of heart valve leaflets is considered a rare cause of thromboembolism, causing ischemic stroke, transient ischemic attack (TIA), acute coronary syndrome, or peripheral thromboembolism. The gold standard for diagnosing LE is transesophageal echocardiography (TEE). Due to the rarity of the disease and lack of significant research, no guidelines exist about the management of LE. Twenty-two papers about LE were reviewed, focusing on the management aspect aiming to assist in guideline publication. Articles were retrieved using PubMed database using “Lambl’s excrescences” as a keyword. All free full text papers up to 2023 were retrieved. In this report, we present the first publication of a case of a TIA secondary to LE in the United Arab Emirates. A 53-year-old male presented with transient attacks of left monocular blindness with complete recovery 2 days later. Extensive stroke work-up was negative, except for TEE, which showed an echo-dense linear mobile structure attached to the aortic surface of the aortic valve closure margin, suggesting LE. As no guidelines exist on the management of LE, the patient was started on Clopidogrel 75 mg daily and remained asymptomatic for 2 years. After reviewing the literature, we suggest the use of Aspirin for patients with ⩾1 embolic event attributed to LE while not on antiplatelets or anticoagulants, as it is the most used and recommended treatment option and is effective in preventing recurrent thromboembolic events.

Lambl’s Excrescence and Management of Recurrent Cerebrovascular Accident (CVA)

“…Given that she was not initially treated, it is impossible to know if she would have had three or more cardioembolic events despite therapy. Vitamin K antagonist therapy was considered; however, given a lack of evidence for superiority, it was not pursued as a treatment strategy due to the significant testing burden and potential interactions with other medications and foods [ 11 , 12 ]. The decision was made to manage conservatively with apixaban and aspirin dual therapy with continued close monitoring and defer escalation to procedural intervention unless and until the patient had an additional CVA despite pharmacologic therapy.…”

A Large Lambl’s Excrescence Causing Embolic Stroke in a Young Patient: A Case Report and Review of Literature

“…9 Mechanistically, due to valvular wear and tear, LEs form on affected valves and act as a nidus for thrombi to accumulate that embolize centrally and peripherally. Although their definite prevalence in asymptomatic patients is unknown, an increasing number of case reports and observational studies have associated LEs with cerebral embolism, 5-7,10-42 acute coronary syndrome, 43-47 peripheral embolism, 19 myocarditis 48 and fatigue 49 in addition to LEs as incidental findings. 50-53 Here, we conduct a comprehensive literature review of reported cases and observational studies pertaining to embolic events associated with LE.…”