1
|
Messiha H, Garster N, Lewandowski D, Pearson PJ, Mohananey D. Subvalvular Thrombosis of the Mitral Valve-A Rare Cause of Cardioembolic Stroke. CASE (PHILADELPHIA, PA.) 2023; 7:492-495. [PMID: 38197120 PMCID: PMC10772932 DOI: 10.1016/j.case.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
•MAC-associated subvalvular thrombosis is a rare cause of cardioembolic stroke. •Thorough evaluation of the MV is important when cardioembolic phenomena are suspected. •Surgical resection is an option in patients with high-risk thrombi.
Collapse
Affiliation(s)
- Heidi Messiha
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Noelle Garster
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Lewandowski
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul J. Pearson
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
2
|
Rahouma M, Khairallah S, Dabsha A, Elkharbotly IAMH, Baudo M, Ismail A, Korani OM, Hossny M, Dimagli A, Girardi LN, Mick SL, Gaudino M. Lung Cancer as a Leading Cause among Paraneoplastic Non-Bacterial Thrombotic Endocarditis: A Meta-Analysis of Individual Patients' Data. Cancers (Basel) 2023; 15:cancers15061848. [PMID: 36980734 PMCID: PMC10047261 DOI: 10.3390/cancers15061848] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Hypercoagulability is strongly associated with cancer and may result in non-bacterial thrombotic endocarditis (NBTE). The aim of our meta-analysis was to explore the demographics and characteristics of this condition in cancer. Databases were systematically searched. The outcomes were to identify the annual trend in premortem diagnosis among the entire cohort and different subgroups and to identify differences in characteristics and survival in the considered population. A total of 121 studies with 144 patients were included. The proportion of marantic endocarditis associated with lung cancer was 0.29 (95% CI, 0.21-0.37; p < 0.001), that associated with pancreatic cancer was 0.19 (95% CI, 0.13-0.27; p < 0.001), that associated with advanced cancer stage (metastasis) was 0.69 (95% CI, 0.61-0.76; p < 0.001), and that associated with adenocarcinoma was 0.65 (95% CI, 0.56-0.72; p < 0.001). Median and 6-month overall survival (OS) were 1.3 months and 32.3%, respectively, with 6-month OS of 20.8% vs. 37.0% in lung vs. other cancers, respectively (p = 0.06) and 42.9% vs. 31.1% among those who underwent intervention vs. those who did not (p = 0.07). Cases discovered in recent years had better survival (HR = 0.98 (95% CI, 0.96-0.99; p = 0.003). While cancer-associated NBTE is a rare entity, lung cancers were the most common tumor site and are frequently associated with more advanced and metastatic cancer stages. The prognosis is dismal, especially among lung cancers.
Collapse
Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Sherif Khairallah
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Anas Dabsha
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Ismail A M H Elkharbotly
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
- General Surgery Department, Newham University Hospital, London E13 8SL, UK
| | - Massimo Baudo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Cardiac Surgery, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Amr Ismail
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Omnia M Korani
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Mohamed Hossny
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Stephanie L Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| |
Collapse
|
3
|
Zmaili MA, Alzubi JM, Kocyigit D, Bansal A, Samra GS, Grimm R, Griffin BP, Xu B. A Contemporary 20-Year Cleveland Clinic Experience of Nonbacterial Thrombotic Endocarditis: Etiology, Echocardiographic Imaging, Management, and Outcomes. Am J Med 2021; 134:361-369. [PMID: 32827467 DOI: 10.1016/j.amjmed.2020.06.047] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nonbacterial thrombotic endocarditis, or marantic endocarditis, is rare. Contemporary data on the etiology, echocardiographic evaluation, and management of nonbacterial thrombotic endocarditis are limited. METHODS A single-center retrospective cohort study was performed. Electronic medical records and echocardiographic records were searched for patients ages ≥18 years with a confirmed diagnosis of nonbacterial thrombotic endocarditis between January 1999 and November 2019. Demographic, echocardiographic, and management data were collected. RESULTS Of 600,577 transthoracic echocardiograms (TTEs) and 89,264 transesophageal echocardiograms (TEEs), 42 patients had nonbacterial thrombotic endocarditis (mean age: 54 ± 14.5 years; 66.7% were female). The median duration of follow-up was 8.2 (interquartile range 3.3-24.4) months. Seventeen patients (40.5%) had malignancy, 33.3% had systemic lupus erythematosus, and 35.7% had antiphospholipid antibody syndrome. Stroke was the most common presentation (59.5%). TTE enabled the diagnosis in 19 cases (45.2%), compared with TEE, which identified the condition in 33 of 34 (97.1%) cases in which it was utilized. Three-dimensional echocardiography was performed in 17 TEEs. The most common valves involved were mitral (61.9%), and aortic (23.8%) valves. Thirty-two patients were managed with anticoagulation. Ten patients underwent surgery. Sixteen (38.1%) patients died, most of whom had a diagnosis of advanced malignancy. CONCLUSION In a contemporary 20-year cohort, TTE and TEE played important roles in diagnosis, with superior diagnostic performance of TEE for nonbacterial thrombotic endocarditis. Mortality was high, and advanced malignancy portended a worse prognosis. Management in most cases was therapeutic anticoagulation. In select cases, surgery provided favorable outcomes.
Collapse
Affiliation(s)
| | - Jafar M Alzubi
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Agam Bansal
- Department of Medicine, Cleveland Clinic, Ohio
| | | | - Richard Grimm
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio.
| |
Collapse
|
4
|
Slivka AP, Agriesti JE, Orsinelli DA. Natural history of nonbacterial thrombotic endocarditis treated with warfarin. Int J Stroke 2020; 16:519-525. [PMID: 33040698 DOI: 10.1177/1747493020961744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report on the natural history of a cohort of patients presenting with transient ischemic attack or stroke and nonbacterial thrombotic endocarditis treated with warfarin.Patients with valvular vegetations on echocardiography, stroke, or transient ischemic attack presenting to a single neurologist were included. All patients were treated with warfarin until the vegetation resolved or for two years, then were switched to aspirin and had at least one clinical and echocardiographic follow-up.Twenty-nine patients were included and followed for a median of 27 months. Average age was 42 years and 72% were female. Two patients had vegetations on two valves. Five patients (17%) had recurrent strokes, three had systemic lupus erythematosus and antiphospholipid antibodies, one had antiphospholipid antibodies alone and one had neither condition. Three of the five patients did not have resolution of the vegetation at the time of the event. The valvular vegetations resolved in 23 of the 31 affected valves (74%) after a median of 11 months (range 4.5-157.5). Eleven patients had at least one follow-up echocardiogram after resolution of the vegetation and none had recurrent vegetations after warfarin was stopped.This study should serve to provide general recommendations regarding treatment of patients with TIA/stroke with nonbacterial thrombotic endocarditis. Valvular vegetations resolve in most patients and the risk of recurrent stroke is low. Warfarin can safely be switched to aspirin in most patients when the vegetation resolves or after two years if it does not resolve. Prolonged warfarin may be warranted in patients with systemic lupus erythematosus, positive antiphospholipid antibodies, and a persistent vegetation.
Collapse
Affiliation(s)
- Andrew P Slivka
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Julie E Agriesti
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - David A Orsinelli
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
5
|
Perrone F, Biagi A, Facchinetti F, Bozzetti F, Ramelli A, Vezzani A, Manca T, Gnetti L, Majori M, Alfieri V, Tiseo M. Systemic thromboembolism from a misdiagnosed non-bacterial thrombotic endocarditis in a patient with lung cancer: A case report. Oncol Lett 2020; 20:194. [PMID: 32952663 PMCID: PMC7479525 DOI: 10.3892/ol.2020.12056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/05/2020] [Indexed: 12/03/2022] Open
Abstract
Thromboembolic events are frequent in patients with cancer, commonly involving the venous and pulmonary circulation. The arterial system is rarely implicated in embolism and, when involved, a cardiogenic origin should always be excluded. In the present study, a case of a patient who developed multiple embolic events concomitantly with the diagnosis of locally-advanced non-small cell lung cancer with high expression levels of programmed death-ligand 1 (PD-L1) in >50% of tumor cells is reported. A cardiac defect interpreted as a patent foramen ovale required low molecular weight heparin administration. Despite the anti-coagulant therapy, before first-line anticancer treatment with pembrolizumab immunotherapy could be administered due to high PD-L1 expression levels, a new hospitalization was required due to the onset of novel ischemic manifestation. New transthoracic and transesophageal echocardiography revealed a previously misdiagnosed vegetation of the mitral valve that caused systemic embolization. The lack of any sign of infection led to the diagnosis of a non-bacterial thrombotic endocarditis (NBTE), whose embolic sprouting gave rise to the widespread ischemic events. No active anticancer treatment was feasible due to the rapid progression of the disease. NBTE can evolve quickly, eventually preventing any chance of treatment targeting the primary cause, which in the present study was lung cancer. If NBTE can be correctly diagnosed sooner then there may be the potential for anticancer therapy that does not worsen the hypercoagulability state, thus improving cancer-associated survival.
Collapse
Affiliation(s)
- Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Andrea Biagi
- Cardiology Department, University Hospital of Parma, I-43126 Parma, Italy
| | - Francesco Facchinetti
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy.,National Institute of Health and Medical Research, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | | | - Andrea Ramelli
- Cardiac Surgery Intensive Care Unit, University of Parma, I-43126 Parma, Italy
| | - Antonella Vezzani
- Cardiac Surgery Intensive Care Unit, University of Parma, I-43126 Parma, Italy
| | - Tullio Manca
- Cardiac Surgery Intensive Care Unit, University of Parma, I-43126 Parma, Italy
| | - Letizia Gnetti
- Unit of Pathology, University of Parma, I-43126 Parma, Italy
| | - Maria Majori
- Unit of Pulmonology and Thoracic Endoscopy, University of Parma, I-43126 Parma, Italy
| | - Veronica Alfieri
- Unit of Respiratory Disease and Lung Function, University of Parma, I-43126 Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy.,Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| |
Collapse
|
6
|
Albitar HA, Almodallal Y, Nishimura R, Iyer VN. Mobile Mitral and Aortic Valvular Masses in Patients With Hereditary Hemorrhagic Telangiectasia Receiving Intravenous Bevacizumab. Mayo Clin Proc Innov Qual Outcomes 2020; 4:460-463. [PMID: 32793873 PMCID: PMC7411168 DOI: 10.1016/j.mayocpiqo.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bevacizumab is now an emerging treatment option for severe hereditary hemorrhagic telangiectasia–related bleeding including epistaxis and gastrointestinal tract bleeding. The impact of long-term intravenous bevacizumab therapy on cardiac structure and function is unknown. We describe 3 patients receiving intravenous bevacizumab therapy for severe hereditary hemorrhagic telangiectasia–related bleeding who were found to have abnormal mobile masses on the mitral valve (n=2) and aortic valve (n=1). The clinical impact of these findings is unknown and requires further study.
Collapse
Affiliation(s)
| | - Yahya Almodallal
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Rick Nishimura
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
7
|
Zakka K, Zakka P, Davarpanah A, Koshkelashvili N, Bilen MA, Owonikoko T, El-Rayes B, Akce M. Nonbacterial Thrombotic Endocarditis and Widespread Skin Necrosis in Newly Diagnosed Lung Adenocarcinoma. Case Rep Oncol 2020; 13:239-244. [PMID: 32308583 PMCID: PMC7154248 DOI: 10.1159/000506453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 01/18/2023] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is a rare entity most commonly diagnosed postmortem with rates in autopsy series ranging from 0.9 to 1.6%. A 63-year-old female with past medical history of hypertension and mitral valve prolapse presented to the hospital with shortness of breath, headache, and necrotic skin lesions on her hands and feet. Computed tomography (CT) scan of her chest demonstrated a pulmonary embolus in the right lower lung segmental artery and right upper lobe lobar to segmental pulmonary artery, a mass-like consolidation in the left upper lung field impeding the hilum. CT scan of the abdomen demonstrated metastatic disease in liver and bone and bilateral femoral deep vein thrombosis. Transesophageal echocardiography revealed severe mitral regurgitation with two small mobile plaques on the mitral valve and two immobile plaques on the descending aorta. Magnetic resonance imaging of the brain was consistent with subacute infarcts and metastatic disease. Bronchoscopy was performed and pathology revealed primary adenocarcinoma of the lung. She was treated with anticoagulation and systemic chemotherapy. The patient and family elected to proceed with hospice due to her clinical decline, poor performance status, and poor prognosis after a prolonged hospital stay. Underlying malignancy is detected in approximately 40–85% of patients with NBTE. Lung cancer is the most frequently associated malignancy followed by pancreatic, stomach, breast, and ovarian cancer. Widespread necrotic skin lesions as presenting symptoms of primary lung adenocarcinoma are rare. In the present case, the diagnosis of necrotic skin lesions and NBTE preceded that of the neoplastic disease. Necrotic skin lesions and NBTE can be the first manifestations of an occult malignancy causing extensive multi-organ infarcts. NBTE can present with such extensive skin lesions as a first presenting sign of malignancy. To the best of our knowledge, this is the first case to present with such extensive skin lesions as the first presenting symptom of lung adenocarcinoma.
Collapse
Affiliation(s)
- Katerina Zakka
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Patrick Zakka
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amir Davarpanah
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Taofeek Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Bassel El-Rayes
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mehmet Akce
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
8
|
Sia CH, Lim JSJ, Poh KK, Chin TM. A classical case of non-bacterial thrombotic endocarditis from pancreatic adenocarcinoma presenting as multiple strokes, myocardial infarction and acute limb ischaemia. Oxf Med Case Reports 2016; 2016:omw084. [PMID: 28031849 PMCID: PMC5184836 DOI: 10.1093/omcr/omw084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/04/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022] Open
Abstract
Non-bacterial thrombotic endocarditis (NBTE) classically presents in the context of pancreatic adenocarcinomas. Echocardiography is useful to investigate for valvular vegetations, and institution of early treatment is crucial as this can be complicated by multiple systemic emboli, leading to significant morbidity or mortality in serious cases. Treatment options involve anticoagulation with unfractionated heparin, and the role of surgical intervention is unclear. In this report, we describe a classical case of a middle-aged lady with unresectable pancreatic adenocarcinoma who developed NBTE complicated by multiple systemic emboli. She eventually succumbed from poor neurological status from multiple cerebral emboli. Awareness of this condition is required by clinicians for early diagnosis and prompt treatment.
Collapse
Affiliation(s)
- Ching-Hui Sia
- University Medicine Cluster , National University Health System , Singapore
| | - Joline Si Jing Lim
- Department of Haematology-Oncology , National University Cancer Institute , Singapore
| | - Kian Keong Poh
- Department of Cardiology , National University Heart Centre Singapore , Singapore
| | - Tan Min Chin
- Department of Haematology-Oncology , National University Cancer Institute , Singapore
| |
Collapse
|
9
|
Kim SA, Park SM, Hwang SH, Kim MN, Son HS, Shim WJ. Unexpected Pathologic Diagnosis of the Mitral Valvular Mass. J Cardiovasc Ultrasound 2016; 23:271-3. [PMID: 26755938 PMCID: PMC4707315 DOI: 10.4250/jcu.2015.23.4.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/22/2022] Open
Abstract
A 59-year-old man with multifocal cerebral infarction was found to have the large obstructive mitral valvular mass. Although benign tumor was under suspicion before surgery, he was finally diagnosed as chronic infective endocarditis by microscopic evaluation. The precise diagnosis and the proper management of a cardiac mass are very important since even the benign tumor may cause fatal complications. However, primary cardiac mass has the broad spectrum from pseudo-tumor to malignancy and the differential diagnosis using non-invasive methods is not easy even with the currently available imaging techniques.
Collapse
Affiliation(s)
- Su-A Kim
- Division of Cardiology, Department of Internal Medicine, Cheil General Hospital, Dankook University College of Medicine, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Mi-Na Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ho-Sung Son
- Department of Thoracic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Wan-Joo Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Lee V, Gilbert JD, Byard RW. Marantic endocarditis – A not so benign entity. J Forensic Leg Med 2012; 19:312-5. [DOI: 10.1016/j.jflm.2012.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 02/15/2012] [Indexed: 12/13/2022]
|
11
|
Ali OF, Ratnaraja N, Nathani N, Bhabra M, Varma C. Postpartum culture negative endocarditis: a case report and review of the current guidelines. BMJ Case Rep 2011; 2011:bcr.03.2011.3935. [PMID: 22679146 DOI: 10.1136/bcr.03.2011.3935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Culture-negative endocarditis (CNE) presents physicians with diagnostic and treatment challenges. Postpartum endocarditis is rare and usually culture negative. Empirical antimicrobial regimes lead to the risk of aggressive treatment with potentially toxic drugs. This paper presents a case of postpartum CNE, discussing the issues of diagnosis and treatment. European and American guidelines for CNE are then reviewed and compared.
Collapse
Affiliation(s)
- Omar F Ali
- Cardiology Department, City Hospital, Birmingham, UK.
| | | | | | | | | |
Collapse
|
12
|
Pons F, Poyet R, Daranda E, Prunet B, Jego C, Boret H, Meaudre E, Goutorbe P, Cellarier GR. [Ischemic strokes as a presenting feature of marantic endocarditis despite heparin treatment]. Ann Cardiol Angeiol (Paris) 2010; 60:233-5. [PMID: 20723881 DOI: 10.1016/j.ancard.2010.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 07/10/2010] [Indexed: 11/28/2022]
Abstract
We report on two patients hospitalized in intensive care unit for ischemic strokes presenting the feature of marantic endocarditis complicating lung's adenocarcinoma. These two cases turned out to be very interesting because of the occurrence of ischemic strokes even though the patients were receiving the recommended treatment, namely anticoagulation with heparin, in well-adjusted doses. The management of nonbacterial thrombotic endocarditis remains a challenge and its mortality is still high.
Collapse
Affiliation(s)
- F Pons
- Service de cardiologie, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, Toulon, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Joshi SB, Richards MJ, Holt DQ, Yan BP, Aggarwal A. Marantic endocarditis presenting as recurrent arterial embolisation. Int J Cardiol 2009; 132:e14-6. [DOI: 10.1016/j.ijcard.2007.07.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
|
14
|
[Nonbacterial thrombotic endocarditis and gastric carcinoma]. Rev Med Interne 2008; 29:673-5. [PMID: 18304702 DOI: 10.1016/j.revmed.2007.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Revised: 12/14/2007] [Accepted: 12/20/2007] [Indexed: 11/21/2022]
Abstract
We report a 74-year-old woman with acute heart failure and recurrent ischemic strokes as the presenting features of a nonbacterial thrombotic endocarditis complicating a gastric adenocarcinoma. The treatment only allowed a few months remission. Diagnosis of nonbacterial thrombotic endocarditis is rarely obtained while the patient is alive. Coagulation abnormalities due to the tumoral process are responsible of the valvular thrombotic process. Anticoagulation with heparin is recommended. Valvular surgery remains controversial.
Collapse
|
15
|
el-Shami K, Griffiths E, Streiff M. Nonbacterial Thrombotic Endocarditis in Cancer Patients: Pathogenesis, Diagnosis, and Treatment. Oncologist 2007; 12:518-23. [PMID: 17522239 DOI: 10.1634/theoncologist.12-5-518] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Thrombophilia is a well-described consequence of cancer and its treatment. The pathogenesis of this phenomenon is complex and multifactorial. Nonbacterial thrombotic endocarditis (NBTE) is a serious and potentially underdiagnosed manifestation of this prothrombotic state that can cause substantial morbidity in affected patients, most notably recurrent or multiple ischemic cerebrovascular strokes. Diagnosis of NBTE requires a high degree of clinical suspicion as well as the judicious use of two-dimensional echocardiography to document the presence of valvular thrombi. In the absence of contraindications to therapy, treatment consists of systemic anticoagulation, which may ameliorate symptoms and prevent further thromboembolic episodes, as well as control of the underlying malignancy whenever possible.
Collapse
Affiliation(s)
- Khaled el-Shami
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA.
| | | | | |
Collapse
|
16
|
Zhang YY, Cordato D, Shen Q, Sheng AZ, Hung WT, Chan DKY. Risk Factor, Pattern, Etiology and Outcome in Ischemic Stroke Patients with Cancer: A Nested Case-Control Study. Cerebrovasc Dis 2006; 23:181-7. [PMID: 17143001 DOI: 10.1159/000097639] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 07/20/2006] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Coagulation disorders are seen in cancer patients, but it is not clear whether cancer predisposes stroke patients to unique characteristics. The aim of the study was to investigate risk factors, pattern,etiology and outcome in stroke patients with cancer. METHODS A retrospective review of all ischemic stroke (IS) patients with cancer (n = 56) admitted to Bankstown-Lidcombe Hospital, Sydney, Australia, between January 1999 and December 2004 was conducted and comparison made to age- and gender-matched noncancer IS patients admitted to the same hospital during the same period. RESULTS Vascular risk factors and stroke pattern were comparable in cancer and noncancer groups. Post-stroke thrombotic episodes (myocardial infarction, deep vein thrombosis or pulmonary emboli) were more common in the cancer group than in the noncancer group (11 vs. 0%, p = 0.031). Depression was also more common in the cancer group than in the noncancer group (14 vs. 2%, p = 0.039). There was a tendency for more patients in the cancer group to die in hospital (30 vs. 14%, p = 0.078). CONCLUSIONS Coagulation disorders were more likely to be seen in stroke cancer patients, and patients with cancer tended to have a higher in-hospital post-stroke mortality. Larger sample size studies may identify further differences in the characteristics of stroke patients with cancer.
Collapse
Affiliation(s)
- Yun Yun Zhang
- Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Sydney, Australia
| | | | | | | | | | | |
Collapse
|
17
|
Numnum TM, Leath CA, Straughn MJ. Synchronous Primary Endometrial and Ovarian Carcinoma in a Patient With Marantic Endocarditis. Obstet Gynecol 2006; 108:748-50. [PMID: 17018489 DOI: 10.1097/01.aog.0000190220.13074.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nonbacterial thrombotic endocarditis (NBTE), or marantic endocarditis, is a rare form of endocarditis found in patients with advanced malignancy and collagen-vascular disorders. There is limited information about the clinical course of patients with NBTE because the majority of cases are found at the time of autopsy. CASE A 38-year-old woman presented to the emergency department with recent onset of chest pain and fatigue. Initial evaluation revealed cardiac valvular disease, and the patient underwent aortic valve replacement. Final pathology revealed nonbacterial thrombotic endocarditis. A metastatic work-up revealed a complex pelvic mass and elevated CA 125. The patient underwent an exploratory laparotomy and was subsequently found to have synchronous primary endometrial and ovarian carcinoma. CONCLUSION Nonbacterial thrombotic endocarditis is rare and carries a high mortality. This case is unusual in that the diagnosis of nonbacterial thrombotic endocarditis led to the diagnosis of a gynecologic malignancy.
Collapse
Affiliation(s)
- T Michael Numnum
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, AL, USA.
| | | | | |
Collapse
|
18
|
Royter V, Cohen SN. Recurrent embolic strokes and cardiac valvular disease in a patient with non-small cell adenocarcinoma of lung. J Neurol Sci 2006; 241:99-101. [PMID: 16318856 DOI: 10.1016/j.jns.2005.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 10/06/2005] [Accepted: 10/10/2005] [Indexed: 11/18/2022]
Abstract
The etiology and mechanisms of stroke could differ in cancer compared to non-cancer patients due to altered blood coagulability and/or non-bacterial thrombotic endocarditis (NBTE). These conditions could be either missed by using inappropriate diagnostic methods or misinterpreted. For instance, certain techniques (transthoracic echocardiography, TTE) may provide false-negative results and delay appropriate therapy. On the other hand, these patients, by having atypical findings, may challenge the differential between bacterial and sterile valvular heart disease. Cerebrovascular disease in cancer patients is often aggressive with tendency to recurrent events and rapid neurological devastation. Timely diagnosis is crucial. Current treatment approach to NBTE includes anticoagulation. We report a case of multiple embolic strokes in a patient diagnosed with lung cancer. Primary and secondary stroke prevention is discussed with relevant review of the literature.
Collapse
Affiliation(s)
- Vladimir Royter
- Division of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | |
Collapse
|
19
|
Rabinstein AA, Giovanelli C, Romano JG, Koch S, Forteza AM, Ricci M. Surgical treatment of nonbacterial thrombotic endocarditis presenting with stroke. J Neurol 2005; 252:352-5. [PMID: 15726268 DOI: 10.1007/s00415-005-0660-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 08/30/2004] [Accepted: 09/07/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Necropsy studies have shown that nonbacterial thrombotic endocarditis (NBTE) may be associated with cerebral infarctions and antemortem diagnosis is now possible. However, the best treatment for patients with NBTE presenting with stroke is not known. We describe three patients presenting with an acute embolic stroke secondary to large,mobile vegetations detected by transthoracic (one case) or transesophageal echocardiography (two cases). All patients underwent surgery for removal of the vegetations to prevent recurrent embolic events; valve replacement was necessary in two cases. The sterile nature of the vegetations was confirmed by pathological examination and negative stains and cultures of the surgical samples. A previously unrecognized hypercoagulable condition was diagnosed in all patients (antiphospholipid antibody syndrome in two cases and disseminated adenocarcinoma in one case). CONCLUSION NBTE should be considered among the possible causes of embolic stroke even in the absence of history of cancer, hypercoagulability, or previous embolic manifestations. If NBTE is diagnosed, the possibility of underlying thrombophilia should be thoroughly investigated. Valvular surgery represents a valuable therapeutic alternative in patients with large mobile vegetations, valvular dysfunction or recurrent embolic events despite anticoagulation.
Collapse
Affiliation(s)
- A A Rabinstein
- Dept. of Neurology, University of Miami School of Medicine, Miami, FL 33101, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Albrich WC, Kraft C, Fisk T, Albrecht H. A mechanic with a bad valve: blood-culture-negative endocarditis. THE LANCET. INFECTIOUS DISEASES 2004; 4:777-84. [PMID: 15567127 DOI: 10.1016/s1473-3099(04)01226-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 33-year-old man with a known bicuspid aortic valve presented with fever, chills, progressive fatigue, anorexia, and night sweats. Echocardiography confirmed aortic-valve endocarditis, but blood cultures remained negative. Bartonella henselae endocarditis was ultimately confirmed by serology as well as by immunohistochemistry and PCR testing of the excised valve. The patient recovered with appropriate antibiotic therapy. B henselae is a common cause of culture-negative endocarditis. It predominantly affects men with underlying valvular disease, and has a predilection for aortic valves. Diagnosis is usually made serologically and with either tissue culture, immunohistochemistry, or PCR. Treatment of this destructive endocarditis consists of a combination of long-term antibiotic therapy and surgical valve repair. This case is used to discuss the approach towards the treatment of patients with endocarditis that is blood-culture negative.
Collapse
Affiliation(s)
- Werner C Albrich
- Division of Infectious Diseases, Emory University Medical School, Altlanta, GA, USA.
| | | | | | | |
Collapse
|
21
|
Abstract
Cardiac imaging, specifically echocardiography, has greatly enhanced the ability of clinicians to effectively diagnose and manage IE. Echocardiograms should generally be obtained in all patients suspected of having IE, both to establish the diagnosis and to identify complicated cardiac involvement that may warrant surgical intervention. Transesophageal imaging is more sensitive and specific than the transthoracic approach and currently represents the optimal approach to echocardiographic imaging. Manifestations of endocardial involvement include vegetations, abscesses, aneurysms, fistulae, leaflet perforations, and valvular dehiscence. The roles of other imaging modalities including CT, MRI, and nuclear imaging have yet to be fully established.
Collapse
Affiliation(s)
- Molly Sachdev
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | | |
Collapse
|
22
|
Fanale MA, Zeldenrust SR, Moynihan TJ. Some unusual complications of malignancies: case 2. Marantic endocarditis in advanced cancer. J Clin Oncol 2002; 20:4111-4. [PMID: 12351608 DOI: 10.1200/jco.2002.20.19.4111] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Sachdev M, Peterson GE, Jollis JG. Imaging techniques for diagnosis of infective endocarditis. Infect Dis Clin North Am 2002; 16:319-37, ix. [PMID: 12092475 DOI: 10.1016/s0891-5520(02)00003-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With the ability to structurally characterize cardiac manifestations, echocardiography is used for the diagnosis and management of infective endocarditis. In establishing the diagnosis according to the Duke criteria, the findings of endocardial involvement (vegetation, abscess, prosthetic valve dehiscence) or new valvular regurgitation represent "major" diagnostic criteria. As echocardiography cannot reliably differentiate noninfective from infective lesions, however, proper diagnosis lies in correlating echocardiography with clinical findings. The more invasive transesophageal approach provides substantially greater image resolution; this approach should be considered first in the evaluation of patients with higher prior probabilities of endocarditis and those with potential endocardial complications.
Collapse
Affiliation(s)
- Molly Sachdev
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | | |
Collapse
|
24
|
Harris KM. A case of confirmed nonbacterial thrombotic endocarditis with correlative transesophageal echocardiographic findings. Echocardiography 2000; 17:45-8. [PMID: 10978959 DOI: 10.1111/j.1540-8175.2000.tb00993.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The diagnosis of nonbacterial thrombotic endocarditis is rarely made during life. We describe a patient with non-Hodgkin's lymphoma with evidence of systemic embolism in which transesophageal echocardiography was useful in establishing the diagnosis. The clinical and echocardiographic features of nonbacterial thrombotic endocarditis should be remembered when a valvular mass is seen on echocardiography.
Collapse
Affiliation(s)
- K M Harris
- Minneapolis Cardiology Associates/Minneapolis Heart Institute, 920 East 28th Street, Suite 300, Minneapolis, MN 55407, USA
| |
Collapse
|
25
|
Vassallo R, Remstein ED, Parisi JE, Huston J, Brown RD. Multiple cerebral infarctions from nonbacterial thrombotic endocarditis mimicking cerebral vasculitis. Mayo Clin Proc 1999; 74:798-802. [PMID: 10473357 DOI: 10.4065/74.8.798] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary vasculitis of the central nervous system (PVCNS) is an uncommon disorder that can present with a variety of symptoms, making diagnosis and management difficult. We describe a case of cerebral infarction that occurred from nonbacterial thrombotic endocarditis (NBTE) and presented with clinical and radiologic imaging features that suggested PVCNS. The patient was a 58-year-old woman with left hemiparesis, aphasia, and episodic confusion. Magnetic resonance imaging of the brain demonstrated multifocal lesions consistent with infarction involving both cerebral hemispheres, and cerebral angiography showed changes consistent with vasculitis. Although brain biopsy findings were normal, the patient was treated for presumed vasculitis with cyclophosphamide and prednisone. Four months later respiratory failure secondary to polymicrobial pneumonia and adult respiratory distress syndrome developed, and she died. Autopsy revealed multiple infarcts in the heart, lungs, right kidney, spleen, and brain. Multiple thrombotic platelet-fibrin vegetations consistent with NBTE were found on all cardiac valves. Examination of the brain revealed no evidence of active or healed vasculitis. Cerebral angiography may show findings that suggest vasculitis, but it is not diagnostic, as several other conditions may cause similar changes. Nonbacterial thrombotic endocarditis may cause multiple cerebral infarctions and can be difficult to distinguish from vasculitis, as specific diagnostic tests for PVCNS are lacking.
Collapse
Affiliation(s)
- R Vassallo
- Thoracic Diseases Research Unit, Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic Rochester, Minn. 55905, USA
| | | | | | | | | |
Collapse
|
26
|
LIBMAN-SACKS ENDOCARDITIS IN A PREGNANT WOMAN WITH ACUTE RESPIRATORY DISTRESS SYNDROME. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199905001-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Abstract
Lupus erythematosus, or LE, is a connective tissue disease that affects a number of organ systems. Patients with this condition can experience several other serious conditions--bleeding, infection, endocarditis, adrenal insufficiency and mucocutaneous disease--that can affect the provision of dental care. The authors describe considerations for managing dental treatment of patients with LE.
Collapse
Affiliation(s)
- S S De Rossi
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, USA
| | | |
Collapse
|