Non-bacterial thrombotic endocarditis

Asopa, Sanjay; Patel, Anish; Khan, Omar; Sharma, Rajan; Ohri, Sunil K.

doi:10.1016/j.ejcts.2007.07.029

Cited by 192 publications

(213 citation statements)

References 32 publications

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“…NBTE is characterized by small, broad-based, irregularly shaped areas of vegetation along coaptation lines without destruction of valvular tissue (5). NBTE lesions are usually found in high-flow areas, such as the distal portion of the leaflets, the atrial surface of the mitral valve and the ventricular aspect of the aortic valve, and in areas damaged by intracardiac lines (7).…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of NBTE in patients with malignancy remains partially elusive, although it is intimately related to cancer-associated thrombophilia, originally described as Trousseau syndrome (2,6). In the presence of excessive clotting factor activity, endothelial damage caused by circulating cytokines, such as tumor necrosis factor and interleukin-1, can trigger platelet deposition in areas of high blood flow (2,5,6). However, the pathogenesis of Trousseau syndrome may be more complicated, in that it may involve tissue factor and tumor-associated cysteine proteinase activity, tumor hypoxia, carcinoma mucin activity associated with platelet aggregation dependent on P-and L-selectins and oncogene activation related to hypercoagulability (9).…”

Section: Discussionmentioning

confidence: 99%

“…NBTE has been reported to be associated with Trousseau syndrome (4). NBTE is characterized by small, broad-based and irregularly shaped areas of vegetation along coaptation lines without destruction of valvular tissue (5).…”

Section: Introductionmentioning

confidence: 99%

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Trousseau Syndrome with Nonbacterial Thrombotic Endocarditis in a Patient with Uterine Cancer

et al. 2013

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This paper aims to describe the usefulness of transthoracic echocardiography in the follow-up of recurrent nonbacterial thrombotic endocarditis (NBTE) associated with neoplastic conditions. A 60-year-old woman with advanced uterine cancer developed recurrent areas of aseptic vegetation on the mitral valve along with cerebral, renal and splenic embolisms. Echocardiographic assessments revealed vegetation and thrombotic events on three occasions. In this case, transthoracic echocardiography was effective in following the decreased frequency of attachment of the NBTE vegetation to the mitral valve and reductions in the size of the area of vegetation following treatment with unfractionated heparin infusion, hysterectomy and chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trousseau Syndrome with Nonbacterial Thrombotic Endocarditis in a Patient with Uterine Cancer

et al. 2013

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“…postpregnancy and severe septicaemia [2]. The main differential diagnosis of NBTE is infective endocarditis.…”

Section: Discussionmentioning

confidence: 99%

Psychosis due to non-bacterial thrombotic endocarditis

Clough¹,

George²,

Duncan³

2010

Age and Ageing

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Non-bacterial thrombotic endocarditis or marantic endocarditis is an uncommon and frequently terminal condition. We report non-bacterial thrombotic endocarditis presenting as a psychotic illness. The underlying cause was found to be adenocarcinoma of the lung. The patient was nursed on a specialist joint medical/psychiatric unit. Many medical illnesses can present with psychosis in older people: this is the first case report of this presentation in non-bacterial thrombotic endocarditis.Keywords: non-bacterial thrombotic endocarditis, marantic endocarditis, psychosis, elderly A 65-year-old lady was admitted as an emergency to a district general hospital with a 1-month history of increasingly paranoid behaviour. She had become increasingly agitated and convinced that her son was being persecuted and tortured. She had had a lobectomy for adenocarcinoma of the lung the previous year. There was no relevant family history or drug history.Physical examination and investigations, including chest X-ray, head CT scan and chest CT scan, were unremarkable. She was well orientated, alert with normal attention span and her Mini Mental State Examination score was 26/30. Temperature was 37°C, pulse 90, sinus rhythm, blood pressure 140/70 mmHg, respiratory rate 24 and oxygen saturation 98%. ECG showed normal sinus rhythm. Her mental state deteriorated, becoming euphoric and more paranoid and she was referred to the psychiatric team who admitted her under Section 2 of the Mental Health Act.She was treated with quetiapine and sodium valproate as a mood stabiliser. She then developed a petechial rash on her legs. She was transferred to a joint psychiatric/medical ward for further investigations and was found to have a systolic murmur over the aortic area and thrombocytopaenia (platelet count 100 × 10 9 l −1 normal 140-450). There were no features of disseminated intravascular coagulation in the blood film, and fibrinogen levels were normal. Urinalysis showed a trace of blood and protein. The sodium valproate was withdrawn as her low platelet count was thought to be possibly drug-related. Six sets of blood cultures were negative, as was an autoantibody screen, including anti-DNA and antiphospholipid antibody. A transthoracic echocardiogram showed thickening of the aortic valve and a possible vegetation. She was treated with intravenous antibiotics for possible endocarditis.Unfortunately, she became increasingly paranoid, convinced that her husband was an imposter and that medical staff were plotting against her and were holding her son hostage. Her mental state continued to deteriorate and her platelet count dropped to 42×10 9 l −1 . She then suddenly developed a left haemianopia and dense left haemiparesis. Her paranoid delusions completely resolved, but her general physical condition deteriorated and she died.Post mortem revealed multiple infarcts in the spleen, lungs, brain and kidney with multiple small vegetations on the aortic valve comprised primarily of fibrin and platelets. In addition, there was metastatic involvem...

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“…It can be due to a noninfectious cause (Asopa et al, 2007) but when the inflammation is associated with an infection, usually bacterial, it is known as infective endocarditis (IE) and is characterized by the development of a large septic thrombus on one of the cardiac valves (Beynon et al, 2006;Moreillon and Que, 2004). As this thrombus grows, it can lead to valve failure or may fragment forming a septic embolus that is associated with high mortality if the target of the embolus is the brain, heart or lung (Homma and Grahame-Clarke, 2003).…”

Section: Introductionmentioning

confidence: 99%