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Cardiac Masses
Published in Takahiro Shiota, 3D Echocardiography, 2020
Sonia Velasco del Castillo, Miguel Angel García-Fernández
Surgical excision is recommended in asymptomatic patients with low surgical risk in fibroelastomas in left valves with a diameter of 1 cm or greater. If they are small, it is difficult to distinguish them from Lambl excrescences, which are masses of connective tissue, avascular, located in the valve closing line and more filiform in appearance (Figure 19.8, ). 3D TEE adds important information in the assessment of a cardiac mass for better definition of the mass, attachment location, and mobility, which could provide guidance for surgical excision.
Morphologic features and pathology of the elderly heart
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Atsuko Seki, Gregory A. Fishbein, Michael C. Fishbein
Age-related changes are seen in all of the cardiac valves although the degree of change differs. Almost all adult aortic valves have nodular thickenings at the centers of the free edges of the cusps—the so-called nodule of Arantii or nodule of Morgagni (60). Lambl’s excrescences, hairlike projections from the nodules, are often seen in older patients. Fenestration of the cusps, firm ridgelike thickening at the bases of the cusps, is also found in elderly aortic valves. None of these changes are functionally significant.
Cardiac masses
Published in Andrew R. Houghton, MAKING SENSE of Echocardiography, 2013
Lambl’s excrescences are small filamentous strands on the ventricular side of the aortic valve. They are a normal finding in the elderly and are thought to arise from ‘wear and tear’ at the edges of the cusps. On echo they can be mistaken for papillary fibroelastomas, but are usually smaller.
Mycotic aneurysm of the ascending aorta due to Escherichia coli: a case report
Published in Acta Cardiologica, 2022
Ines Zekhnini, Danae Halleux, Rodolphe Durieux, Jean Olivier Defraigne, Marc Radermecker, Vincent Tchana-Sato
She underwent urgent surgery. A median sternotomy was performed, and extracorporeal circulation (ECC) was established between the right atrium and the right axillary artery. The anterior mediastinum was massively infiltrated by an inflammatory tissue with pus. The affected AA was completely resected under moderate hypothermic circulatory arrest (25 °C). The surrounding inflammatory tissues were extensively debrided. The AV was explored, and there was no vegetation. The AV leaflets were thickened, with the presence of small strands on the left cusp (Lambl’s excrescences), which were resected. In situ reconstruction of the AA was carried out with a cryopreserved homograft from the supracoronary level up to the origin of the innominate artery (Figure 2). The patient was successfully weaned from the ECC with catecholamine support. She was extubated on postoperative day (POD) 6 because of delayed awakening. She stayed 12 days in the intensive care unit (ICU).
The Clinical Dilemma of Cardiac Fibroelastic Papilloma
Published in Structural Heart, 2018
Amin Sabet, Mina Haghighiabyaneh, Henry Tazelaar, Ajit Raisinghani, Anthony DeMaria
Unfortunately, there are no specific pathognomonic features or criteria on echocardiogram that can be used to make the diagnosis of CPFE. On echocardiogram they often appear as small, round and pedunculated masses, in an echodense formation with well-demarcated borders (Figures 3 and 4; Supplemental Videos 1, 2). CPFEs have been reported to have a speckled pattern with a characteristic stippling along the edges, which correlates with the finger-like papillary projections on the surface of the tumor (Figure 5).3,4,49,50 This feature is best seen on TEE, which has higher resolution and allows for the individual finger-like projections to be distinguished.3,49 Despite these characteristics, echocardiography may often fail to differentiate CPFEs from other cardiac masses. Included in the differential diagnosis of CPFE are vegetations, other cardiac tumors, thrombi, valvular calcifications, and Lambl’s excrescences (Table 1).2,51–53 In such cases, the additional use of other imaging modalities may be helpful. The uptake of tracer activity on positron emission tomography can occur in patients with infectious endocarditis and point to that diagnosis. Although the disappearance of the mass after treatment with antibiotics or anticoagulants suggests the diagnosis of infectious endocarditis or thrombus respectively, it must be remembered that CPFE may embolize without symptoms. It has been reported that CPFEs have been found incidentally at surgery in 9 of 725 (2) and 41 of 88 (18) patients, although the precise reason for the surgery was not delineated.
Diagnostic imaging in infective endocarditis: a contemporary perspective
Published in Expert Review of Anti-infective Therapy, 2020
Natalia E. Castillo Almeida, Pooja Gurram, Zerelda Esquer Garrigos, Maryam Mahmood, Larry M. Baddour, M. Rizwan Sohail
TEE has several advantages over TTE and has a high negative predictive value for native valve IE [22]. If the clinical suspicion remains high, a repeat TEE may be warranted in 5 to 7 days as recommended by the 2015 ESC or 3–5 days as recommended by the 2015 AHA guidelines [3,15]. While TEE has a superior image quality when compared to that of TTE, septic vegetations may not be differentiated from aseptic echodensities such as thrombi, Lambl’s excrescences, and myxomatous valvular degeneration resulting in false-positive findings.