Cluster Lambl's Excrescence on the Aortic Valve: A Case Report and Literature Review

Authors

  • Ge Liu  Department of Cardiac surgery, The First Affiliated Hospital of Bengbu Medical University, 233004 Bengbu, Anhui, China
  • Shaofeng Yang Department of Cardiac surgery, The First Affiliated Hospital of Bengbu Medical University, 233004 Bengbu, Anhui, China
  • Chongwen Shen Department of Cardiac surgery, The First Affiliated Hospital of Bengbu Medical University, 233004 Bengbu, Anhui, China
  • Shengqiang Zhang Department of Cardiac surgery, The First Affiliated Hospital of Bengbu Medical University, 233004 Bengbu, Anhui, China
  • Chao Shi  Department of Cardiac surgery, The First Affiliated Hospital of Bengbu Medical University, 233004 Bengbu, Anhui, China
  • Wenjie Diao Department of Cardiac surgery, The First Affiliated Hospital of Bengbu Medical University, 233004 Bengbu, Anhui, China

DOI:

https://doi.org/10.59958/hsf.7179

Keywords:

lambl's excrescence, excrescence, aortic valve, case report, literature review

Abstract

Background: Lambl's excrescence (LE) presents challenges due to its small size and elusive nature. Methods: We present a case of an asymptomatic LE patient in which the patient recovered well and a literature review of LE involving the aortic valve (AV). Results: Transthoracic echocardiography revealed 10 × 4 mm strips of highly echoic attachment on the AV, swinging on the aortic side with high motion. The pathological analysis confirmed LE. The patient underwent surgical management, and the excrescence was successfully removed without damaging the AV. No complications were reported during the 18-month follow-up period. Of the 53 patients with LE (including the one in our report) aged 8–80, 18 were female, and 35 were male. The lengths of the LEs ranged from 1 to 32 mm. There were 6 asymptomatic cases, 25 ischemic stroke cases, 1 myocardial infarction case, 15 cases underwent surgical treatment, and 8 cases underwent simple surgical excision of the LE. The commonly used anticoagulants included warfarin, aspirin, clopidogrel, and rivaroxaban. The 27 patients were followed up with good results. Conclusion: For smaller LE, anticoagulants should be taken for a long time and monitored closely. We recommend surgical resection for large LE (longer than 2 cm), patients who have had more than one stroke, or those undergoing other simultaneous intracardiac operations.

References

Shrestha B, Pokhrel A, Oke I, Paudel A, Timlisina B, Parajuli P, et al. Lambl's Excrescences Associated with Cardioembolic Stroke. The American Journal of Case Reports. 2022; 23: e934859.

Alajjuri MA, Alajjuri OA, Alani FR. Lambl's Excrescence as an Etiology of Thromboembolism: Case Report and Literature Review. Clinical Medicine Insights. Case Reports. 2023; 16: 11795476231171391.

Leitman M, Tyomkin V, Peleg E, Shmueli R, Krakover R, Vered Z. Clinical significance and prevalence of valvular strands during routine echo examinations. European Heart Journal. Cardiovascular Imaging. 2014; 15: 1226–1230.

Ammannaya GKK. Lambl's Excrescences: Current Diagnosis and Management. Cardiology Research. 2019; 10: 207–210.

Cha SD, Incarvito J, Fernandez J, Chang KS, Maranhao V, Gooch AS. Giant Lambl's excrescences of papillary muscle and aortic valve: echocardiographic, angiographic, and pathologic findings. Clinical Cardiology. 1981; 4: 51–54.

Aggarwal A, Leavitt BJ. Images in clinical medicine. Giant Lambl's excrescences. The New England Journal of Medicine. 2003; 349: e24.

Aziz F, Baciewicz FA Jr. Lambl's excrescences: review and recommendations. Texas Heart Institute Journal. 2007; 34: 366–368.

Jaffe W, Figueredo VM. An example of Lambl's excrescences by transesophageal echocardiogram: a commonly misinterpreted lesion. Echocardiography (Mount Kisco, N.Y.). 2007; 24: 1086–1089.

Nakahira J, Sawai T, Katsumata T, Imanaka H, Minami T. Lambl's excrescence on aortic valve detected by transesophageal echocardiography. Anesthesia and Analgesia. 2008; 106: 1639–1640.

Kalavakunta JK, Peddi P, Bantu V, Tokala H, Kodenchery M. Lambl's excrescences: a rare cause of stroke. The Journal of Heart Valve Disease. 2010; 19: 669–670.

Rhee HY, Choi HY, Kim SB, Shin WC, Kim SH. Acute Ischemic Stroke in a Patient with a Native Valvular Strand. Case Reports in Neurology. 2010; 2: 91–95.

Liu RZ, Yu SY, Li Y. Migraine-like headache and ischemic strokes in two patients with Lambl's excrescences. Chinese Medical Journal. 2012; 125: 3346–3348.

Morgan JA, Paone G. Resection of Lambl's excrescence on the aortic valve in a patient with rheumatic mitral valve disease and a left atrial thrombus. The Heart Surgery Forum. 2012; 15: E215–E217.

Wu TY, Gerber IL, Roxburgh RH. Thrombo-embolic cerebral infarction secondary to giant Lambl's excrescence. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia. 2013; 20: 1632–1634.

Yacoub HA, Walsh AL, Pineda CC. Cardioembolic stroke secondary to Lambl's excrescence on the aortic valve: a case report. Journal of Vascular and Interventional Neurology. 2014; 7: 23–25.

Davogustto G, Fernando RR, Loghin C. Lambl's excrescence, migrainous headaches, and ``tiger stripes": puzzling findings in one patient. Texas Heart Institute Journal. 2015; 42: 70–72.

Marstrand P, Jensen MB, Ihlemann N. Valvular Excrescences: A Possible Transient Phenomenon. Case Reports in Cardiology. 2015; 2015: 380765.

Chu A, Aung TT, Sahalon H, Choksi V, Feiz H. Lambl's Excrescence Associated with Cryptogenic Stroke: A Case Report and Literature Review. The American Journal of Case Reports. 2015; 16: 876–881.

Zampi G, Pergolini A, Tinti MD, Alessi C, Sommariva L. Pitfall in Echocardiography: infective endocarditis or valvular strand? Case report. Medical Ultrasonography. 2015; 17: 256–258.

Pizzuti A, Parisi F, Mosso L, Cali' Quaglia F, Tomasello A. Acute Myocardial Infarction in a Patient with Two-Vessel Occlusion and a Large Lambl's Excrescence. Case Reports in Cardiology. 2016; 2016: 8370212.

Kamran H, Patel N, Singh G, Pasricha V, Salifu M, McFarlane SI. Lambl's excrescences: A case report and review of the literature. Clinical Case Reports and Reviews. 2016; 2: 486–488.

Chong-Lei R, Sheng-Li J, Rong W, Cang-Song X, Yao W, Chang-Qing G. Diagnosis and Treatment of Lambl's Excrescence on the Aortic Valve. The Heart Surgery Forum. 2018; 21: E148–E150.

Amin H, Jilani MH, Villarreal D. Lambl's Excrescences: An Enigma of Modern Diagnostic Cardiology. Cureus. 2019; 11: e6407.

Çöllüoğlu T, Önalan O. An unusual cause of lacunar infarcts: Lambl's excrescences on aortic valve shown in detail by 3D transesophageal echocardiography. Oxford Medical Case Reports. 2019; 2019: omz110.

Elkattawy S, Noori MAM, Sah A, Hasan Kazmi SM, Desai D. Lambl's Excrescences Associated With Left Frontal Ischemic Stroke: A Case Report. Cureus. 2020; 12: e9371.

Figueiredo C, Rebelo CS, Lemos J. Cryptogenic Stroke and Valvular Strands. European Journal of Case Reports in Internal Medicine. 2020; 7: 001928.

Hirayama T, Morioka H, Fujiwara H, Iwamoto K, Kiyozuka T, Takeo H, et al. An Autopsy Case of Lambl's Excrescences with Trousseau Syndrome that Caused Cardioembolic Stroke. Internal Medicine (Tokyo, Japan). 2020; 59: 3085–3088.

Hakobyan N, Ilerhunmwuwa N, Wasifuddin M, Jamal F, Zagoruychenko T. An Unusual Source of Cerebral Embolism Caused by Lambl's Excrescences. Cureus. 2023; 15: e40910.

Ramanan S, Singh H, Ahmed O, Zande M, Trimble M. A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity. Cureus. 2023; 15: e46434.

Hurrell H, Roberts-Thomson R, Prendergast BD. Non-infective endocarditis. Heart (British Cardiac Society). 2020; 106: 1023–1029.

Daveron E, Jain N, Kelley GP, Luer WH, Fermin C, Helmcke F, et al. Papillary fibroelastoma and Lambl's excrescences: echocardiographic diagnosis and differential diagnosis. Echocardiography (Mount Kisco, N.Y.). 2005; 22: 461–463.

Ahmad A, Arghami A, El-Am EA, Foley TA, Kurmann RD, Klarich KW. Case Report: A Tale of a Cardiac Mass: Looks Like a Papillary Fibroelastoma, Acts Like a Non-bacterial Thromboendocarditis. Frontiers in Cardiovascular Medicine. 2021; 8: 782926.

Voros S, Nanda NC, Thakur AC, Winokur TS, Samal AK. Lambl's Excrescences (Valvular Strands). Echocardiography (Mount Kisco, N.Y.). 1999; 16: 399–414.

Roldan CA, Shively BK, Crawford MH. Valve excrescences: prevalence, evolution and risk for cardioembolism. Journal of the American College of Cardiology. 1997; 30: 1308–1314.

Mito M, Kiyuna M, Toda T, Sakugawa H, Nakada M, Yoza H, et al. A rare case report of incarceration of Lambl's excrescence of aortic valve resulting in myocardial infarction. Rinsho Byori. The Japanese Journal of Clinical Pathology. 2012; 60: 758–761.

Velho FJP, Dotta F, Scherer L, Bartholomay E, da Silva DA, Fernandes JG, et al. Association between the effect of spontaneous contrast in the thoracic aorta and recent ischemic stroke determined by transesophageal echocardiography. Arquivos Brasileiros de Cardiologia. 2004; 82: 47–51, 52–56.

Xie W, Wang X, Li R, Jia Z, Miao S, Liu Y, et al. Migraine-like headache in subjects with isolated Lambl's excrescences: a case series and literature review. The International Journal of Neuroscience. 2024; 1–9.

Salehi Omran S, Chaker S, Lerario MP, Merkler AE, Navi BB, Kamel H. Relationship between Lambl's excrescences and embolic strokes of undetermined source. European Stroke Journal. 2020; 5: 169–173.

Published

2024-03-20

How to Cite

Liu , G., Yang, S., Shen, C., Zhang, S., Shi , C., & Diao, W. (2024). Cluster Lambl’s Excrescence on the Aortic Valve: A Case Report and Literature Review. The Heart Surgery Forum, 27(3), E295-E301. https://doi.org/10.59958/hsf.7179

Issue

Section

Systematic Review