Valve strands are strongly associated with systemic embolization: A transesophageal echocardiographic study

Freedberg, Robin S.; Goodkin, Gregory M.; Perez, John L.; Tunick, Paul A.; Kronzon, Itzhak

doi:10.1016/0735-1097(95)00394-0

Cited by 105 publications

(70 citation statements)

References 11 publications

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“…Freedberg, et al suggested that our patient's lesions could have been Lambl's excrescences, which are seen on pathologic examination of the valve strands to be highly mobile, fine, threadlike excrescences less than 1 mm in width. 5) Distinguishing between PFE and giant Lambl's excrescences is very difficult on echocardiography. The former may have a more sessile or broader stalk than the latter.…”

Section: Discussionmentioning

confidence: 99%

“…Transthoracic echocardiography revealed an L-R shunt toward the pulmonary trunk, severe pulmonary regurgitation, and severe tricuspid regurgitation, however detected no intracardiac mass. Cardiac catheterization revealed a pulmonary/systemic flow ratio of 2.5, pulmonary artery systolic pressure of 83 mm Hg, mean pulmonary artery pressure of 53 mm Hg, pulmonary capillary wedge pressure of 23 mm Hg, and pulmonary artery resistance of 984 dynes ⋅ sec/cm 5 . No significant coronary stenosis was observed by coronary angiography.…”

Section: Simultaneous Surgery For Patent Ductus Arteriosus Associatedmentioning

confidence: 99%

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Simultaneous Surgery for Patent Ductus Arteriosus Associated with Papillary Fibroelastoma

Morishita

Tomioka

Katahira

et al. 2014

ATCS

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We describe a case of patent ductus arteriosus (PDA) in a 76-year-old woman with a history of stroke, atrial fibrillation, and chronic obstructive pulmonary disease. Cranial diffusion-weighted imaging (DWI) performed for preoperative assessment showed a hyperintense lesion in the left cerebellum. Preoperative transesophageal echocardiography (TEE) demonstrated two highly mobile masses approximately 5 mm in diameter adherent to the left and non-coronary cusps of the aortic valve. We performed transpulmonary patch closure of PDA under hypothermic circulatory arrest. Subsequently, two frond-like masses were completely shaved off the cusps, preserving the native aortic leaflets. Pathological examination confirmed the diagnosis of papillary fibroelastoma (PFE). To our knowledge, this is the first report of PDA associated with PFE. Perioperative use of TEE is an effective tool for management of cardiovascular patients with suspected cardiogenic embolism.

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Section: Discussionmentioning

confidence: 99%

Section: Simultaneous Surgery For Patent Ductus Arteriosus Associatedmentioning

confidence: 99%

Simultaneous Surgery for Patent Ductus Arteriosus Associated with Papillary Fibroelastoma

Morishita

Tomioka

Katahira

et al. 2014

ATCS

View full text Add to dashboard Cite

show abstract

“…In a retrospective analysis, valvular strands on native and prosthetic valves were found in 5.5% of patients referred to TEE [4] and in 0.94% of patients aged 61-70 referred to both TTE and TEE [5]; as most of the patients who undergo TEE have a suspect of endocarditis or of a potential cardiac source of embolism, there could be a bias of selection, which makes differential diagnosis more challenging. That is the case of our patient, which is paradigmatic, as she was referred to TEE for suspect vegetation on the aortic valve; in this case a good clue of its real nature was the echocardiographic features of the finding, which was thin, highly mobile, regularly shaped and attached on the ventricular side of an otherwise normal aortic valve.…”

Section: Discussionmentioning

confidence: 99%

“…In previous reports strands account for a higher risk of stroke or embolism [4], but there is consensus in a conservative strategy of follow up for silent, asymptomat- ic lesions accidentally discovered. In our case, despite the patient was asymptomatic for prior cerebrovascular events, antiplatelet therapy was chosen, given the fact that she was considered at higher risk for her previous history of myocarditis and heart failure.…”

Section: Discussionmentioning

confidence: 99%

Pitfall in Echocardiography: infective endocarditis or valvular strand? Case report

et al. 2015

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“…In other studies, valvular strands were reported in 6.3 to 22.5% of stroke patients compared with 0.3 to 12% of control subjects. 7,8 A thrombotic or fibrotic origin was suggested by the development of valvular strands during thrombolytic therapy for a mitral valvular thrombus. 9 However, the finding that valvular strands are associated with ischemic stroke does not necessarily mean that they are the active embolic source.…”

Section: Discussionmentioning

confidence: 99%

Focal adherent thrombus in the common carotid artery: clinical, ultrasonographic, and pathogenic aspects in two cases.

Devuyst

Bray

Despland

et al. 2000

Journal of Ultrasound in Medicine

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Thrombi within the carotid artery usually occur in vessels with severe atherosclerotic lesions and may embolize to cause TIAs and ischemic brain infarctions. The risk factors and potential causes for carotid artery thrombus formation in the absence of atherosclerosis are currently only speculative (e.g., embolic occlusion from a cardiac source). 1 Furthermore, a focal adherent thrombus involving the CCA is even more exceptional because of the rarity of severe atherosclerotic disease in this large and nonturbulent vessel. 1,2 A thrombus lodged in the CCA has been reported in only a very few cases in the literature. 2 We present two patients with a focal adherent thrombus in the CCA diagnosed by ultrasonography and confirmed by neuroimaging. The aim of this work is to investigate the ultrasonographic features of this very uncommon finding in young stroke patients. CASE 1A 44 year old woman was admitted to our center in October 1998 for an acute brain infarction in the left MCA territory. The brain MR imaging showed multiple vascular ischemic lesions, these being recent in the left ACA and left MCA territories and old in the right ACA territory. The MR angiography revealed an adherent process (0.5 × 4.2 cm) in the left CCA that was confirmed by CT angiography (Fig. 1). Neither MR angiography nor CT angiography showed any typical signs of a dissection of the left CCA but did show a focal adherent thrombus, resulting in a CCA stenosis of 70 to 80% in lumen diameter reduction. Color duplex flow imaging using a transmission frequency of 4.0 MHz (Acuson 128 XP/10, Mountain View, CA) revealed (1) a slightly decreased flow in the left ICA (PSV = 66 cm/s; EDV = 31 cm/s) as compared with the right ICA (PSV = 76 cm/s; EDV = 37 cm/s) and (2) turbulences manifested by an aliasing phenomenon without significant increase of the blood flow velocities in the left CCA (PSV = 75 cm/s; EDV = 20 cm/s) versus those in the right CCA (PSV = 67 cm/s; EDV = 15 cm/s). Color duplex flow imaging also showed a regular adherent isoechoic lesion on the posterior wall in the left CCA (Fig. 2), with dimensions of 0.4 × 3.8

show abstract

Valve strands are strongly associated with systemic embolization: A transesophageal echocardiographic study

Abstract: Valvular strands visualized by transesophageal echocardiography are associated with systemic embolization.

Cited by 105 publications

References 11 publications

Simultaneous Surgery for Patent Ductus Arteriosus Associated with Papillary Fibroelastoma

Simultaneous Surgery for Patent Ductus Arteriosus Associated with Papillary Fibroelastoma

Pitfall in Echocardiography: infective endocarditis or valvular strand? Case report

Focal adherent thrombus in the common carotid artery: clinical, ultrasonographic, and pathogenic aspects in two cases.

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