Valvular Excrescences: A Possible Transient Phenomenon.

Area of Science:

• Cardiology
• Neurology
• Pathology

Background:

• Lambl excrescences (LE) are generally considered to have low thrombogenic potential.
• Fibroelastomas, a type of benign tumor, are known to be a source of thrombi.
• Multiple strokes over a six-year period prompted investigation into potential cardiac sources.

Purpose of the Study:

• To investigate the cause of multiple strokes in a patient with a suspected aortic valve lesion.
• To differentiate between Lambl excrescences and fibroelastoma as the source of thromboembolism.
• To highlight the importance of pre-operative imaging in diagnosing cardiac abnormalities.

Main Methods:

• Review of patient history including multiple stroke events.
• Diagnostic imaging, specifically Transesophageal Echocardiography (TEE).
• Differential diagnosis between Lambl excrescences and fibroelastoma based on imaging and clinical presentation.

Main Results:

• A lesion on the aortic valve was initially diagnosed as fibroelastoma.
• The lesion was not visualized during pre-operative TEE, leading to abortion of aortic valve replacement surgery.
• Re-evaluation of earlier TEE findings and the transient nature of the lesion led to the diagnosis of Lambl excrescences.

Conclusions:

• Lambl excrescences, despite their minimal thrombogenic potential, can be associated with embolic events.
• Pre-operative Transesophageal Echocardiography (TEE) is essential for accurate diagnosis and surgical planning.
• Misdiagnosis can lead to unnecessary surgical interventions.