Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
Published: July 2023
AI Article Synopsis
Article Abstract
An elderly female with metastatic adenocarcinoma of the lung and atrial fibrillation presented with multiple embolic strokes while on anticoagulation with Apixaban. After further investigation, a TEE showed lesions of non-bacterial thrombotic endocarditis on the mitral valve. A decision to switch the patient to LMWH for anticoagulation was then made and a follow-up TEE showed resolution of the NBTE. In this abstract, we show that heparin should remain as the anticoagulation agent of choice in the setting of NBTE associated with malignancy.
Background: Very limited data indicate that patients with stroke from cancer-associated NBTE (Ca-NBTE) exhibit a characteristic pattern of widely distributed ischemic lesions of varying sizes.
Methods: An electronic search of Mayo Clinic records (03/31/2002-06/30/2022) with ensuing manual review of brain magnetic resonance imaging (MRI) was performed to identify topographic characteristics of stroke from Ca-NBTE.
Non-bacterial thrombotic endocarditis (NBTE), formerly recognized as marantic endocarditis, represents a rare cardiovascular pathology intricately linked with hypercoagulable states, notably malignancy and autoimmune disorders. Characterized by the development of sterile vegetations comprised of fibrin and platelets on cardiac valves, NBTE poses a diagnostic challenge due to its resemblance to infective endocarditis. Therapeutic endeavours primarily revolve around addressing the underlying aetiology and instituting anticoagulant regimens to forestall embolic events, with surgical intervention seldom warranted.
Calcified amorphous tumors of the heart are rare, non-cancerous masses made up of calcified nodules and fibrous tissue, often linked to conditions like mitral annular calcification, especially in patients with kidney issues.
A case study of a 77-year-old woman with lung cancer revealed a tumor in her heart, which was surgically removed and identified as a calcified amorphous tumor, despite her normal kidney function.
The findings imply that there may be a connection between calcified amorphous tumors and cancer, potentially due to alterations in blood coagulation from the malignancy.
Non-bacterial thrombotic endocarditis is a rare condition characterized by the formation of thrombotic vegetations on heart valve leaflets, leading to valvular dysfunction, heart failure and thromboembolic events. It is known to be associated with other diseases and some cases remain undiagnosed or can be diagnosed in the postmortem analysis. Surgical excision of the mass may be necessary to prevent further embolic events and other complications.
• AV vegetation due to NBTE is a rare complication in patients with APLAS. • TEE is superior to TTE for detecting small lesions/masses on heart valves. • Management of AV vegetation is extremely challenging.
