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Bagheri A, Khani M, Akbari T, Ghadirzadeh E, Charkazi E, Ghorbani P. Trivalvular nonbacterial thrombotic endocarditis in a patient with colon adenocarcinoma: a case report. J Med Case Rep 2023; 17:334. [PMID: 37545010 PMCID: PMC10405455 DOI: 10.1186/s13256-023-04070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Nonbacterial thrombotic endocarditis is a rare complication of prothrombotic states such as neoplasms that can cause valvular dysfunction and life-threatening complications. Nonbacterial thrombotic endocarditis usually affects the left-sided valves; however, only a minority of cases involving the tricuspid valve have been reported in medical literature. CASE PRESENTATION The current report describes trivalvular involvement by nonbacterial thrombotic endocarditis in a 54-year-old Azeri female patient with metastatic colorectal carcinoma. This case underlines the necessity of evaluating nonbacterial thrombotic endocarditis as a possible consequence in cancer patients. When thromboembolic events are found in the presence of a hypercoagulable state (such as malignancy) and no growth on blood cultures, nonbacterial thrombotic endocarditis could be suspected as the cause. CONCLUSION It is critical to achieve early diagnosis in such a setting to initiate treatment plans and prevent further complications rapidly.
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Affiliation(s)
- Abdolhamid Bagheri
- Department of Cardiology, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, P.O. Box 1998734383, Tehran, Iran
| | - Mohammad Khani
- Department of Cardiology, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, P.O. Box 1998734383, Tehran, Iran
| | - Tooba Akbari
- Department of Cardiology, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, P.O. Box 1998734383, Tehran, Iran
| | - Erfan Ghadirzadeh
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Parastoo Ghorbani
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Kurmann R, El-Am E, Ahmad A, Abbasi MA, Mazur P, Akiki E, Anand V, Herrmann J, Casanegra AI, Young P, Crestanello J, Bois MC, Maleszewski JJ, Klarich K. Cardiac Masses Discovered by Echocardiogram; What to Do Next? STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100154. [PMID: 37520139 PMCID: PMC10382990 DOI: 10.1016/j.shj.2022.100154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 02/12/2023]
Abstract
Cardiac tumors are rare conditions, typically diagnosed on autopsy, but with the advancement of imaging techniques they are now encountered more frequently in clinical practice. Echocardiography is often the initial method of investigation for cardiac masses and provides a quick and valuable springboard for their characterization. While some cardiac masses can be readily identified by echocardiography alone, several require incorporation of multiple data points to reach diagnostic certainty. Herein, we will provide an overview of the main clinical, diagnostic, and therapeutic characteristics of cardiac masses within the framework of their location.
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Affiliation(s)
- Reto Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elias Akiki
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ana I. Casanegra
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip Young
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie C. Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph J. Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kyle Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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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.
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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
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Muacevic A, Adler JR, Arad A, Kalmnovich G, Herzog E. Multi-Valvular Non-bacterial Thrombotic Endocarditis Causing Sequential Pulmonary Embolism, Myocardial Infarction, and Stroke: A Case Report and Literature Review. Cureus 2022; 14:e32261. [PMID: 36620810 PMCID: PMC9815786 DOI: 10.7759/cureus.32261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Non-bacterial thrombotic endocarditis is an uncommon entity that tends to be related to malignancy or rheumatological disorders. The diagnosis is complex and requires a high index of suspicion. It commonly causes recurrent emboli; however, coronary embolism remains an infrequently reported entity. Herein we report a unique case of sequential pulmonary embolism, ST-elevation myocardial infarction (MI), and stroke associated with multi-valvular non-bacterial thrombotic endocarditis. The cornerstone of management is treating the underlying cause and anticoagulation therapy. Surgical treatment should be considered in patients with acute heart failure secondary to valvular dysfunction and recurrent thromboembolism despite proper anticoagulation. We have performed an extensive literature search and found nine cases of established antemortem diagnosis of myocardial infarction secondary to non-bacterial thrombotic endocarditis, and we reviewed them according to cause, treatment, and outcome.
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Fernandes JR, Rodrigues AC, Bernardino VR, Panarra A. Non-bacterial Thrombotic Endocarditis as a Rare Manifestation of Early Stage Gastric Cancer. Cureus 2022; 14:e25213. [PMID: 35747008 PMCID: PMC9212896 DOI: 10.7759/cureus.25213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 01/09/2023] Open
Abstract
Endocarditis is an inflammation of the endocardium and is characterized by the presence of vegetation, which may occur in the context of infectious or non-infectious diseases. Despite the higher rate of infective endocarditis diagnosis, it may also surge in other non-infectious conditions such as cancer or chronic inflammatory syndromes. Cancer defines a hypercoagulable state, and cancer-associated thrombophilia can have a diverse clinical presentation, most commonly venous thromboembolism and rarely non-bacterial thrombotic endocarditis (NBTE). The diagnosis of NBTE is difficult and requires a high level of suspicion. The treatment relies on anticoagulant therapy, control of underlying disease, and valve replacement when applied. Independently of the etiology, without treatment, endocarditis may lead to valve dysfunction and to the worst prognosis. In this paper, we describe a case of a patient with persistent fever and NBTE of the tricuspid valve, disclosing a rare presentation of gastric cancer.
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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. Front Cardiovasc Med 2021; 8:782926. [PMID: 34869697 PMCID: PMC8632806 DOI: 10.3389/fcvm.2021.782926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Benign cardiac tumors and tumor like conditions are a heterogeneous collection of mass lesions that vary widely in their characteristics, such as presentation, size, and location. In some instances, these tumors are found incidentally, and therefore a broad differential diagnosis should be considered. Case: An elderly male with significant unintentional weight loss and a high risk for cancer presented with an incidental valvular cardiac mass. The mass was thought to be a non-bacterial thromboendocarditis on initial clinical evaluation. After multiple imaging modalities, the mass was suspected to be a papillary fibroelastoma (PFE), which was resected due to high stroke risk and multiple previous chronic infarcts on brain MRI. Conclusion: This case highlights the need for a comprehensive cardiac evaluation of a valvular tumor to discern the etiology and rule out other underlying pathophysiological processes that may require alternative interventions to cardiac surgery.
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Affiliation(s)
- Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Edward A El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Thomas A Foley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Division of Cardiovascular Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Reto D Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Heart Center, Kantonsspital Luzern, Lucerne, Switzerland
| | - Kyle W Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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Van Herck J, Thoen H, Delens C, Voet J. Multi-territory stroke preceded by pulmonary embolism with asymptomatic coronavirus disease 2019: a case report. Eur Heart J Case Rep 2021; 5:ytab471. [PMID: 34993406 PMCID: PMC8728730 DOI: 10.1093/ehjcr/ytab471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 01/19/2023]
Abstract
Background Non-bacterial thrombotic endocarditis is characterized by the presence of sterile vegetations on a cardiac valve. We present a case of multi-territory stroke caused by embolism of a non-bacterial thrombotic aortic valve endocarditis, leading to the diagnosis of a prostate adenocarcinoma with bone metastases. Case summary A 66-year-old patient was diagnosed with pulmonary embolism, first attributed to an asymptomatic coronavirus disease 2019 infection. Edoxaban was started, which was discontinued by the patient. Four weeks later, he presented with subacute vertigo and balance disorders. Magnetic resonance imaging showed a multi-territory stroke. A transoesophageal echocardiogram demonstrated a small vegetation on the aortic valve with moderate aortic insufficiency. Blood cultures remained negative. Malignancy screening showed a markedly elevated prostate-specific antigen. Prostate adenocarcinoma was confirmed on biopsy. A positron emission tomography revealed metastatic disease. A diagnosis of non-bacterial thrombotic endocarditis and paraneoplastic pulmonary embolism secondary to prostate cancer was made. Edoxaban was restarted and the patient was referred for treatment of the prostate adenocarcinoma. Follow-up after 5 months showed no evidence of aortic valve vegetations. Discussion Coronavirus disease 2019 in ambulatory patients may be insufficient as a predisposing factor for venous thrombo-embolism and these patients, especially the elderly, should undergo a screening for malignancy. Non-bacterial thrombotic endocarditis is a rare cause of multi-territory stroke. When related to cancer, the prostate can be the primary tumour.
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Affiliation(s)
- Jakob Van Herck
- Department of Cardiology, General Hospital AZ Nikolaas, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium.,Department of General Internal Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - Hendrik Thoen
- Department of Cardiology, General Hospital AZ Nikolaas, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium.,Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Christophe Delens
- Department of Cardiology, General Hospital AZ Nikolaas, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Joeri Voet
- Department of Cardiology, General Hospital AZ Nikolaas, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
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Toyoshima H, Nakanura B, Tanigawa M, Tanaka H, Nakanishi Y, Sakabe S. Non-bacterial thrombotic endocarditis with cryptogenic stroke. Clin Case Rep 2021; 9:e04833. [PMID: 34552744 PMCID: PMC8443433 DOI: 10.1002/ccr3.4833] [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: 04/21/2021] [Revised: 07/06/2021] [Accepted: 08/29/2021] [Indexed: 01/09/2023] Open
Abstract
Negative blood culture and pathological findings are helpful to diagnose non-bacterial thrombotic endocarditis. The treatment strategy, including lifelong anticoagulation or surgery, should be individualized based on patients' underlying diseases.
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Affiliation(s)
- Hirokazu Toyoshima
- Department of Infectious DiseasesJapanese Red Cross Ise HospitalIseJapan
| | - Bun Nakanura
- Department of Thoracic and Cardiovascular SurgeryMie UniversityTsuJapan
| | - Motoaki Tanigawa
- Department of Respiratory MedicineJapanese Red Cross Ise HospitalIseJapan
| | - Hiroyuki Tanaka
- Department of Infectious DiseasesJapanese Red Cross Ise HospitalIseJapan
| | - Yuki Nakanishi
- Department of Infectious DiseasesJapanese Red Cross Ise HospitalIseJapan
| | - Shigetoshi Sakabe
- Department of Infectious DiseasesJapanese Red Cross Ise HospitalIseJapan
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Geng T, Song Z, Wang B, Dai S, Xu Z. Thrombus management during direct coronary intervention for acute myocardial infarction. Am J Transl Res 2021; 13:6784-6789. [PMID: 34306427 PMCID: PMC8290728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To study the management of thrombus during direct coronary intervention in patients with acute myocardial infarction (AMI). METHODS We retrospectively analyzed 332 acute myocardial infarction patients receiving coronary artery intervention in our hospital from May 2017 to May 2019. Among them, 221 patients received thrombus aspiration and 111 patients received thrombus aspiration combined with platelet membrane glycoproteins receptor antagonist. The propensity score matching 1:1 nearest neighbor matching method was adopted to match 50 cases of the two methods as the control group and the experimental group, respectively. The incidence rate of intraoperative and postoperative adverse reactions, the effective rate of treatment, the electrocardiogram (ECG) at 1 h after operation, and the echocardiographic results at 1 week after operation were compared between the two groups. RESULTS The incidence rate of adverse reactions in the experimental group was significantly lower than that in the control group, (P<0.05). The incidence rate of postoperative adverse reactions in the two groups did not statistically differ (P>0.05). The effective rate was found to be substantially higher in the experimental group when compared with that of the control group (P<0.05). The ECG 1 h after operation was in favor of the experimental group (P<0.05). The echocardiography results 1 week after operation were not statistically different in the two groups (P>0.05). CONCLUSION Thrombus aspiration combined with receptor antagonist yielded a desirable outcome in direct coronary intervention for AMI, and has a high application value.
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Affiliation(s)
- Tao Geng
- Department of Cardiovascular Disease, Cangzhou Central Hospital Cangzhou, China
| | - Zhiyuan Song
- Department of Cardiovascular Disease, Cangzhou Central Hospital Cangzhou, China
| | - Bingxun Wang
- Department of Cardiovascular Disease, Cangzhou Central Hospital Cangzhou, China
| | - Shipeng Dai
- Department of Cardiovascular Disease, Cangzhou Central Hospital Cangzhou, China
| | - Zesheng Xu
- Department of Cardiovascular Disease, Cangzhou Central Hospital Cangzhou, China
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