[Non-bacterial thrombotic endocarditis: a rare case of recurrent embolic events]

Non bacterial thrombotic endocarditis is a rare disease. The real incidence is not known and seems to range from 0.9 to 9.3%. Generally it is associated with cancer and rarely diagnosed antemortem. We describe the case of a female patient who suffered from ictus cerebri and acute myocardial infarction. She was admitted with diagnosis of papillary fibroelastoma arising from the right aortic leaflet. Her past medical history was characterized by gastrectomy, splenectomy and partial pancreatectomy for gastric cancer. The patient underwent successful resection of the mass that was attached to the right leaflet of the aortic valve closed to the aortic annulus. The histopathological examination revealed a mass composed of only thrombotic material. At the follow-up 1 year later the patient was in good clinical conditions (NYHA functional class I). Transthoracic echocardiography showed a good ventricular function, a continent aortic valve without recurrent mass. The suspicion of non bacterial thrombotic endocarditis should be aroused when diagnosis of endocardial mass is made in patients with previous cancers.