Recurrent Cardio-embolic Cerebrovascular Accidents due to Lambl’s Excrescences?

Pramod Theetha Kariyanna^1, , Apoorva Jayaranagaiah², Yuliya Kats³ and Abhishek Sharma³

¹Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, U.S.A.

²Department of Internal Medicine, Marshfield Clinic- St.Joseph Hospital, Marshfield, Wisconsin, U.S.A.

³Division of Cardiology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, U.S.A.

Cite this paper

Pramod Theetha Kariyanna, Apoorva Jayaranagaiah, Yuliya Kats and Abhishek Sharma. Recurrent Cardio-embolic Cerebrovascular Accidents due to Lambl’s Excrescences?. American Journal of Medical Case Reports. 2016; 4(3):93-96. doi: 10.12691/AJMCR-4-3-6

Abstract

Cerebrovascular accidents (strokes) are leading cause of morbidity and mortality in the United States of America. Cardioembolic strokes account for one-third of cerebrovascular accidents. Lambl’s excrescences are filiform projections on the native cardiac valves; they are attributed as a rare cause of cardioembolic strokes. They are a result of endothelial damage secondary to valve wear and tear. Lambl’s excrescences as a cause of cardioembolic stroke is debated. Lambl’s excrescences are a frequent appearance on echocardiography. We here present a case of recurrent cardioembolic strokes in whom lambl’s excrescences on aortic valves were detected on transesophageal echocardiography. Previous transthoracic echocardiography in the patient had not revealed lambl’s excrescences owing to their low sensitivity. Patient refused aortic valve replacement and medical management of cerebrovascular accident was continued.

Keywords

Lambl’s excrescences, aortic valve, transthoracic echocardiography, cardioembolic stroke

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Mozaffarian D, Benjamin EJ, Go AS, et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics—2015 Update. A Report from the American Heart Association. Circulation.2015;131:00-00.
[2]	Samsa GP, Bian J, Lipscomb J, et al. Epidemiology of Recurrent Cerebral Infarction A Medicare Claims–Based Comparison of First and Recurrent Strokes on 2-Year Survival and Cost. Stroke. 1999;30:338-349.
[3]	Arboix A, Alio J. Cardioembolic Stroke: Clinical Features, Specific Cardiac Disorders and Prognosis. Curr Cardiol Rev. 2010 Aug; 6(3): 150-161.
[4]	Caplan LR. Brain embolism. In: Caplan LR, Hurst JW, Chimowitz MI, editors. Clinical Neurocardiology. Marcel Dekker: New York; 1999:35-185.
[5]	Leary MC, Caplan LR. Cerebrovascular disease and neurologic manifestations of heart disease. In: Fuster V, Alexander RW, O'Rourke RA, Roberts R, King 3rd, et al, editors. Hurst's the Heart, 12th ed. McGraw-Hill: New York; 2007.
[6]	Lambl VD. Papillare excrescenzen an der semilunar-klappe der aorta. Wien Med Wochenschr. 1856;6:244-7.
[7]	Yacoub HA, Walsh AL, Pineda CC. Cardioembolic stroke secondary to Lambl’s excrescence on the aortic valve: a case report. J Vasc Interv Neurol. 2014 Sep; 7(3): 23-25.
[8]	Nakahira J, Sawai T, Katsumata T, et al. Lambl’s Excrescence on Aortic Valve Detected by Transesophageal Echocardiography. 2008;106(6):1639-1640.
[9]	Shirani M, Bradlow M, Metveyeva P, et al. Transient loss of vision as the presenting symptom of papillary fibroelastoma of aortic valve - two dimensional echocardiographic recognition. Cardiovasc Pathol. 1997;6:237-240.
[10]	Nakahira J, Sawai T, Minami T. Pathologic Examination of Lambl’s Excrescence. Journal of Cadiothoracic and vascular anesthesia. 2014;28(1);e3-e4.
[11]	Roldan CA, Shively BK, Crawford MH. Valve excrescences: prevalence, evolution and risk for cardioembolism. J Am Coll Cardiol. 1997 Nov 1;30(5):1308-14.
[12]	Dumitrascu O, Tsimerinov. Recurrent ischemic strokes and headaches originating from Lambl’s excrescence. Neurology April 6.2015;84(14):P2.273.
[13]	Quinson P, de Gevigney G, Boucher F, et al. Fibrous aortic valve tumor (Lambl's excrescence) trapped in the right coronary artery. Apropos of a case. Arch Mal Coeur Vaiss. 1996 Nov;89(11): 1419-23.
[14]	Lopex-Sanchez E, Munroz EF, Martinez JAA, et al. Central retinal artery occlusion as the initial sign of aortic valve papillary fibroelastoma. American Journal of Ophthalmology. 2001; 131(50): 667-669.
[15]	Rbaibi A, Bonnevie L, Guiraudet O, et al. Importance of transesophageal echocardiography and computed tomography in the differential diagnosis of a case of papillary fibroelastoma revealed by a neurologic accident. Arch Mal Coeur Vaiss.2002 Jun; 95(6):601-5.
[16]	Fitzgerald D, Gaffney P, Dervan P, et al. Giant Lambl's excrescence presenting as a peripheral embolus. Chest. 1982 Apr;81(4):516-7.
[17]	Kalavakunta JK, Peddi P, Bantu V, et al. Lambl’s Excrescences: A Rare Cause of Stroke. The Journal of Heart Valve Disease 2010;19:669-670.
[18]	Roldan CA, Shively BK, Crawford MH, Valve Excrescences: Prevalence, Evolution and Risk for Cardioembolism. J Am Coll Cardiol. 1997;30(5):1308-1314.
[19]	Wolf RC, Spiess J, Vasic N. Valvular Strands and Ischemic Stroke. Eur Neurol 2007;57:227-231.
[20]	Homma S, Di Tullio MR, Sciacca RR, et al. Effect of aspirin and warfarin therapy in stroke patients with valvular strands. Stroke. 2004 Jun;35(6):1436-42.
[21]	Aziz F, Baciewicz FA. Lambl's Excrescences. Tex Heart Inst J. 2007; 34(3): 366-368.