Multiple Lambl's excrescences with subvalvular extension, a rare cause of cryptogenic stroke: treated by port-access cardiac surgery

Al-Ansari, Sali; Hindori, Vikash; Riezebos, Robert K.; Yilmaz, Alaaddin

doi:10.1136/bcr-2013-201161

Cited by 12 publications

(14 citation statements)

References 13 publications

(11 reference statements)

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“…These filiform strands are often incidental finding and may confuse clinicians to differentiate between mobile thrombus or pedunculated myxoma or cardiac papillary fibroelastomas. There are several evidences to support that these clusters of LE may break from the atrioventricular valve and cause thromboembolic events and predispose the patients to adverse events like myocardial infarction, stroke, pulmonary embolism, ventricular fibrillation, and retinal artery embolism [2,[4][5][6][7][8][9][10]. LE should be considered in the differential diagnosis for a patient with embolic stroke of undetermined source.…”

Section: Discussionmentioning

confidence: 99%

Lambl’s Excrescence Associated with Recurrent Ischemic Strokes

Patel

Bhesania

Malik

et al. 2019

SN Compr. Clin. Med.

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Background Lambl's excrescence (LE) is a rare thin, mobile, filiform frond on the endocardial surface of cardiac valves responsible for recurrent ischemic strokes due to embolic phenomena. Due to nonspecific symptoms, sometimes the diagnosis is challenging. It can be diagnosed by transesophageal echocardiogram (TEE) with increased sensitivity. Several case reports have been published with a strategy to manage LE but there is lack of consensus. We report a case of a 75-year-old patient with the LE arising from aortic valve resulting in recurrent ischemic strokes within a short period and its management. Case A 75-year-old male with multiple vascular risk factors presented with confusion, altered mental status of unknown onset and aphasia. He denied weakness, numbness, or other focal neurological deficits. National Institute of Health Stroke Scale was 5. IV tPA was not given due to the unknown onset of symptoms. The magnetic resonance imaging (MRI) revealed acute/subacute left thalamic lacunar infarct. TEE demonstrated a 7-mm linear fibrinous mass on the valve. The patient was on aspirin which was changed to clopidogrel. After 2 weeks, the patient readmitted with similar presentation. MRI showed subacute right parietal cortical infarct. The patient was advised to proceed with surgical resection of LE. Due to refusal for surgery, he was kept on 30 days cardiac monitor and had given anticoagulant therapy for secondary prevention of stroke. Conclusion Although wide range from single or dual antiplatelet therapy to full dose anticoagulation have been tried, surgical intervention should be considered in case of multiple ischemic strokes to mitigate the risk of embolism.Keywords Lambl's Excrescence . Cardiac tumor . Papillary fibroelastomas . Acute ischemic stroke . Embolic stroke . Embolic stroke of undetermined source (ESUS) Urvish K. Patel and Siddharth Bhesania contributed equally to this work.

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Section: Discussionmentioning

confidence: 99%

Lambl’s Excrescence Associated with Recurrent Ischemic Strokes

Patel

Bhesania

Malik

et al. 2019

SN Compr. Clin. Med.

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“…Those patients also experienced positive outcomes, similar to those managed conservatively. [17,19,21,23] Kalavakunta [3] 59 y/o M Aortic valve CVA Warfarin No further neurological deficits that hospital course…”

Section: Discussionmentioning

confidence: 99%

“…[6,[13][14][15] While no standard management for LEx currently exists, various case reports describe the management of patients who have stroke-like symptoms using anticoagulation, antiplatelet, surgical excision, and conservative management. [3,8,16,17] In this report, we present a case of TIA likely secondary to embolism of LEx on the aortic side of the native aortic valve. We also conducted a comprehensive literature review with an emphasis on different therapeutic strategies utilized to provide insight for future encounters.…”

Section: Introductionmentioning

confidence: 95%

Lambl’s excrescences and a review of therapeutic strategies

Osorio

Hou

et al. 2018

CRIM

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Background: Lambl’s excrescences (LEx) are thin, filiform structures that arise on the lines of closure of heart valves. Although rare, we have come across various case reports in the literature describing thromboembolic events associated with LEx. We report the case of a 63-year-old female who presented with TIA-like symptoms and was found to have a LEx on the aortic side of native aortic valve. We conducted a comprehensive literature review with emphasis on different therapeutic strategies utilized to provide insight for future encounters.Case presentation: A 63-year-old female with a past medical history significant for hypertension and hyperlipidemia presented to the emergency room with symptoms of dysarthria and unsteady gait. While in the hospital, the patient returned to her baseline gait and speech without intervention. Work-up for including computed tomography of the head, magnetic resonance imaging, and carotid doppler, as well as prolonged telemetry monitoring was negative. A transthoracic echocardiogram showed a 0.81 cm linear echodensity attached to the aortic side of the aortic valve, highly suggestive of LEx that was later confirmed on transesophageal echocardiogram. Patient was placed on clopidogrel alone for antiplatelet therapy due to an aspirin allergy and she was subsequently discharged home.Discussion: No standard management for LEx currently exists. We aim to add to the evidence of effective management and explore the literature of patients who have experienced TIA/CVA symptoms secondary to LEx.

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“…In these cases LE should be differentiated from papillary fibroelastoma (PFE) (Table 1). Indeed, in the literature, a number of the cases are reported as giant LE and at the end appear to be PFE [8–11]. …”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction in a Patient with Two-Vessel Occlusion and a Large Lambl’s Excrescence

Pizzuti

Parisi

Mosso

et al. 2016

Case Reports in Cardiology

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A 59-year-old man underwent an echocardiography study after myocardial infarction and it showed a thin, mobile mass attached to the aortic valve. A diagnosis of Lambl's excrescence (LE) was suspected. Coronary occlusion as a consequence of embolism of LE's material could not be excluded and the patient underwent surgical excision. Histology confirmed the diagnosis; however a differential diagnosis with papillary fibroelastoma could not be established because both of these structures are histologically indistinguishable. A brief survey of the literature is presented. Evidence-based recommendations for treatment have not been established yet.

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Multiple Lambl's excrescences with subvalvular extension, a rare cause of cryptogenic stroke: treated by port-access cardiac surgery

Cited by 12 publications

References 13 publications

Lambl’s Excrescence Associated with Recurrent Ischemic Strokes

Lambl’s Excrescence Associated with Recurrent Ischemic Strokes

Lambl’s excrescences and a review of therapeutic strategies

Acute Myocardial Infarction in a Patient with Two-Vessel Occlusion and a Large Lambl’s Excrescence

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