Diagnosis and surgical treatment for isolated tricuspid libman-sacks endocarditis: a rare case report and literatures review

Bai, Zhixuan; Hou, Jianglong; Ren, Wen-jun; Guo, Yingqiang

doi:10.1186/s13019-015-0302-1

Cited by 14 publications

(14 citation statements)

References 18 publications

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“…Association between APS and NBTE presenting as a myxoma-like mass has been previously described in the literature, but only in female patients [ 4 ]. The same has been the case for isolated tricuspid valve NBTE associated with APS [ 8 ]. A literature review revealed only scarce reported cases of NBTE presenting as large vegetations in male patients with APS, and those found were restricted to the aortic valve, which is a more common site of NBTE involvement [ 10 ].…”

Section: Discussionmentioning

confidence: 54%

“…Nonbacterial thrombotic endocarditis is usually characterized by sessile, wart-like vegetations that range from pinhead to 3-4 mm in size and most commonly involve the mitral and aortic valves [ 3 ]. Although rare, several cases of isolated tricuspid valve involvement related to APS have been reported in the literature [ 8 ]. Cardiac masses in patients with APS have proved challenging to physicians, with NBTE vegetations being occasionally misdiagnosed as myxomas due to presenting with similar characteristics on imaging, as well as the possibility of APS and a primary cardiac neoplasm coexisting [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical trials are still necessary to further evaluate said treatment options and develop more robust therapies for NBTE in patients with APS. Currently, surgery is still recommended in those patients presenting with severe valvular regurgitation leading to symptoms of heart failure [ 4 , 8 ]. Nonetheless, recognizing cardiac masses attributable to NBTE in APS would give a selected group of patients the possibility to undergo a trial of medical management before surgical intervention became necessary.…”

Section: Discussionmentioning

confidence: 99%

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Nonbacterial Thrombotic Endocarditis of the Tricuspid Valve in a Male Patient with Antiphospholipid Syndrome

Yordan-Lopez

Hernández-Suárez

Marshall-Perez

et al. 2018

Cureus

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Valve vegetations in nonbacterial thrombotic endocarditis consist of fibrin and platelet aggregates and can be related to circulating immune complexes, such as in the case of antiphospholipid syndrome. In patients with primary antiphospholipid syndrome, echocardiographic studies have disclosed heart valve abnormalities in about a third of patients. Unusual associations between antiphospholipid syndrome and nonbacterial thrombotic endocarditis include presentation as an intracardiac mass compatible with a myxoma on imaging studies, as well as isolated involvement of the tricuspid valve. Both of these scenarios have been previously reported in female patients. This article presents the case of a 53-year-old Hispanic male with antiphospholipid syndrome who presented to the hospital with symptoms of heart failure and persistent right calf pain. An intracardiac mass attached to the anterior leaflet of the tricuspid valve was found through transthoracic echocardiography. Further imaging studies suggested the mass to be a myxoma and the patient underwent mass excision with tricuspid valve replacement. Pathology report of the surgical specimen was consistent with a diagnosis of nonbacterial thrombotic endocarditis. This case highlights the importance of considering nonbacterial thrombotic endocarditis as a key differential diagnosis in patients with concomitant antiphospholipid syndrome and intracardiac masses, as well as challenges encountered in diagnosis and management.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Nonbacterial Thrombotic Endocarditis of the Tricuspid Valve in a Male Patient with Antiphospholipid Syndrome

Yordan-Lopez

Hernández-Suárez

Marshall-Perez

et al. 2018

Cureus

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“…The landmark lesion of IE is the vegetation (Figure 1) [57]. In this context, IDUs population with vegetations >20 mm may present higher embolic risk [58] and higher mortality as well [25,58,59].…”

Section: Diagnosismentioning

confidence: 99%

“…TOE has higher sensibility in the detection of pulmonary vegetations [62]. When clinical manifestations sustain IE with negative or unclear TTE, TOE has high sensitivity (>90%) and may reveal: (1) vegetations; (2) paravalvular or intracardiac abscess, (3) new valvular regurgitations, and (4) prosthetic valve dehiscence (Figure 2) [57,63,64].…”

Section: Diagnosismentioning

confidence: 99%

Infective Endocarditis in Intravenous Drug Users: Surgical Treatment

Moldovan¹,

Molnar²,

Costache³

et al. 2019

Infective Endocarditis

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Intravenous drug use is associated with infective endocarditis. Besides, it does appear that left-sided infective endocarditis is a feature of general population, whereas right-sided infective endocarditis is common in intravenous drug users. The most common etiology of right-sided infective endocarditis in intravenous drug users is Staphylococcus aureus in about 75% followed by streptococci, Gramnegative bacilli and fungi. In case of intravenous drug users with infective endocarditis, optimal treatment strategies lack a general consensus. Additionally, the best indication and timing of surgery are debatable. To overcome these problems, the early and complete surgical debridement of infected tissue together with microbial therapy assures a good prognosis in the long term.Keywords: endocarditis, drug-associated endocarditis, intravenous drug abuser endocarditis, intravenous drug users, right heart endocarditis Infective Endocarditis 2 the right-sided IE, tricuspid valve is affected in 90% cases [21], whereas pulmonic valve represents about 10% from right-sided IE cases [3,18,24]. Up to now, isolated right-sided IE involving the pulmonary valve, the eustachian valve, interventricular septum, or right ventricular free wall have been described [17,21,25]. MicrobiologyAccording to current evidence, IE among IDUs presents a large spectrum of microbial pathogens (Table 1) [26][27][28][29][30][31].Pathogens as Pseudomonas aeruginosa, other gram-negative microorganisms, fungi, enterococci, streptococci, and polymicrobial infections occur less frequently [16]. Importantly, other pathogens noted in IDUs are oral bacteria such as Prevotella intermedia, Haemophilus parainfluenzae, S. constellatus, and E. corrodens [32][33][34][35][36].The most common etiology of right-sided IE in IDUs is Staphylococcus aureus (S. aureus) in about 75% [1,4,6,[37][38][39] followed by streptococci, Gram-negative bacilli, and fungi [40]. In fact, published data supports the involvement of S. aureus among IDUs in 40-74% cases of IE [38,41,42]. S. aureus is the most common cause of tricuspid valve endocarditis regardless of associated risk factors in IDUs [1,4,16,18,43].The incidence of negative blood cultures is reported as 2.5-31% and is associated with delayed diagnosis and treatment [44], with large vegetations [45], and with highest morbidity and mortality [16,45,46].Regarding HIV, a prevalence of HIV as high as 60% among IDUs has been reported by centers from Europe and the USA [11,40]. HIV is more common among IDUs with right-sided IE than left-sided IE [47].Polymicrobial endocarditis is characteristically for IDUs [48] and may involve microorganisms such as Bartonella spp., Candida spp., or Tropheryma whipplei [49]. The presence of E. corrodens should aware the likelihood of polymicrobial IE with embolic complications and relapses. In fact, there is a synergism between streptococci and E. corrodens [50][51][52].

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Non‐surgical extirpation of a non‐infectious expanding tricuspid valve mass by percutaneous aspiration thrombectomy

Asllanaj

Urzua

Dota

et al. 2022

Cathet Cardio Intervent

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Marantic endocarditis refers to a noninfectious lesion, usually in the aortic and mitral valves, that is most commonly seen in advanced malignancy and systemic lupus erythematosus. Inflammatory conditions, including antiphospholipid syndrome (APS), are a rare etiology making up less than 20% of reported cases. The condition is thought to be due to a hypercoagulable state and found postmortem with rates in autopsy series ranging from 0.9% to 1.6%. In comparison to infective endocarditis, marantic endocarditis has a greater tendency for valve vegetations to embolize.Common treatment modalities include anticoagulation or valve replacement.Although percutaneous aspiration thrombectomy of right-sided heart chamber thrombi exists, there are limited reports demonstrating its use with regards to treatment of right-sided endocarditis. We present the case of an older male with a history of Factor V Leiden and APS who was admitted due to a rapidly expanding mass on the tricuspid valve (TV). Despite serial blood cultures being negative, the patient received adequate antibiotic therapy for more than 4 weeks. Transthoracic echocardiogram showed an enlarged TV vegetation with an increased diameter from 10 to 30 mm over 6 weeks. Due to the patient's high operative risk and concern for embolization complications, a multidisciplinary decision was made to perform percutaneous aspiration thrombectomy of the TV vegetation. Subsequent biopsy of the lesion confirmed it was noninfectious and nonmalignant. Thus, the patient was started on systemic anticoagulation for prevention of thromboembolic events.

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Diagnosis and surgical treatment for isolated tricuspid libman-sacks endocarditis: a rare case report and literatures review

Cited by 14 publications

References 18 publications

Nonbacterial Thrombotic Endocarditis of the Tricuspid Valve in a Male Patient with Antiphospholipid Syndrome

Nonbacterial Thrombotic Endocarditis of the Tricuspid Valve in a Male Patient with Antiphospholipid Syndrome

Infective Endocarditis in Intravenous Drug Users: Surgical Treatment

Non‐surgical extirpation of a non‐infectious expanding tricuspid valve mass by percutaneous aspiration thrombectomy

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