The valvulopathy of non-bacterial thrombotic endocarditis

Non-bacterial thrombotic endocarditis (NBTE) is a rare disorder characterized by sterile, thrombotic vegetations of the heart valves. Clinically, NBTE occurs in the setting of various malignancies and autoimmune phenomena, notably antiphospholipid syndrome. Echocardiographically, NBTE can resemble infective endocarditis, acute rheumatic fever and chronic rheumatic disease. The thrombotic lesions of NBTE carry significant embolic potential, and do not respond uniformly to anticoagulation. Valve deformity, resulting in severe stenotic and/or regurgitant lesions, while rare, may necessitate surgical intervention. Herein is described the case of a young female with a history of a spontaneous abortion who presented with an ischemic neurologic event. Transesophageal echocardiography revealed multiple mitral valve vegetations. Repeated negative blood cultures along with persistently elevated anticardiolipin antibody titers suggested a diagnosis of non-bacterial thrombotic endocarditis secondary to antiphospholipid syndrome. The pathology, echocardiographic findings, clinical features and treatment of this uncommon valvulopathy are discussed.