Diagnosis and Treatment of Lambl’s Excrescence on the Aortic Valve
Objective: Our objective is to summarize our experience in the diagnosis and treatment of Lambl’s excrescence (LE) on the aortic valve.Â
Methods: The clinical data of 25 patients with LE admitted to our hospital from January 2010 to December 2014 were analyzed retrospectively. There were 17 males and 8 females, with the mean age of 55.7 Â± 11.43 years (range: 30 to 70 years). Among the patients analyzed, eight also had cerebral embolism. All of the patients were diagnosed by transesophageal echocardiography (TEE). In seven cases, surgical treatment to remove the excrescence was successfully performed.Â
Results: All 25 patients were cured and discharged. There were no complications or operative mortalities in the seven patients that underwent surgical treatment. Follow-ups were performed for all patients for an average of 2.9 Â± 1.5 years. During this time, none had a new cerebrovascular accident (CVA).Â
Conclusions: Most patients with LE are asymptomatic, though some patients showed repeated episodes of stroke. We recommend TEE as the main diagnostic means of the disease. Patients with LE that have experienced two or more CVAs or combined other heart disease and need open heart surgery should be offered surgical excision of the excrescences. Other patients should be treated conservatively with anticoagulation, or monitored closely.
Aggarwal A, Leavitt BJ. 2003. Giant lambl’s excrescences. N Engl J Med 349:25.
Armstrong WF. 1997. Valve excrescences: harmless and common or strokes-in-waiting? J AmColl Cardiol 30:1315-6.
Aziz F, Baciewicz, FA Jr. 2007. Lambl’s Excrescences: review and recommendations. Tex Heart Inst J 34:366-8.
Cohen A, Tzourio C, Chauvel C, et al. 1997. Mitral valve strands and the risk of ischemic stroke in elderly patients. Stroke 28:1574-8.
Daveron E, Jain N, Kelley GP, et al. 2005. Papillary fibroelastoma and Lambl’s excrescences: echocardiographic diagnosis and differential diagnosis. Echocardiography 22:285-7.
Freedberg RS, Goodkin GM, Perez JL, et al. 1995. Valve strands are strongly associated with systemic embolization: a transesophageal echocardiographic study. J Am Coll Cardiol 26:1709-12.
Jaffe W, Figueredo VM. 2007. An example of lambl’s excrescences by transesophageal echocardiogram: a commonly misinterpreted lesion. Echocardiography 24:1086-9.
Kalavakunta JK, Peddi P, Bantu V, et al. 2010. Lambl’s excrescences: a rare cause of stroke. J Heart Valve Dis 19:669-70.
Leitman M, Tyomkin V, Peleg E, et al. 2014. Clinical significance and prevalence of valvular strands during routine echo examinations. Eur Heart J Cardiovasc Imaging 15:1226-30.
Melduni RM, Klarich KW, Nesbitt GC, et al. 2008. Lambl’s excrescences: is surgical excision really necessary? Tex Heart Inst J 35:89.
Nakahira J, Sawai T, Katsumata T, et al. 2008. Lambl’s excrescence on aortic valve detected by transesophageal echocardiography. Anesth Analg 106:1639-40.
Nighoghossian N, Derex L, Loire R, et al. 1997. Giant lambl excrescences: an unusual source of cerebral embolism. Arch Neurol 54:41-4.
Roldan CA, Schevchuck O, Tolstrup K, et al. 2015. Lambl’s excrescences: association with cerebrovascular disease and pathogenesis. Cerebrovasc Dis 40:18-27.
Roldan CA, Shively BK, Crawford MH. 1997. Valve excrescences: prevalence, evolution and risk for cardioembolism. J Am Coll Cardiol 30:1308-14.