Lambl's excrescences: review and recommendations

Lambl's excrescences are filiform fronds that occur at sites of valve closure. They originate as small thrombi on endocardial surfaces (where the valve margins contact) and have the potential to embolize to distant organs. We describe the case of a 61-year-old woman who presented with repeated episodes of stroke. She was found to have Lambl's excrescences on all 3 leaflets of the aortic valve. After all other possible causes of stroke were ruled out, she underwent successful open heart surgery for débridement of these excrescences. The histopathologic diagnosis was consistent with Lambl's excrescences. Our patient did not have any cerebrovascular embolic event after surgery. Because of its high sensitivity to detect excrescences, transesophageal echocardiography should be included in the diagnostic assessment of all patients who have experienced strokes. Asymptomatic patients who are found to have evidence of Lambl's excrescences should be monitored closely. If there is evidence of 1 cerebrovascular accident in a patient with Lambl's excrescences, anticoagulation is advised. Any suggestion of a 2nd such episode should lead to operative removal of Lambl's excrescences.