Lambl's excrescences (LEs) are unusual, yet significant etiology of thromboembolism. LEs are fibrous valvular strands typically occurring at coaptation lines of the left-sided valves. These occur from wear and tear of the valves and comprise of a dense core of collagenous and elastic fibrils enclosed by endothelium. Transesophageal echocardiography (TEE) remains the gold standard in its diagnosis. Asymptomatic LEs are closely monitored, while symptomatic lesions with history of thromboembolism are managed with antiplatelet drugs or are anticoagulated. Surgery is indicated in case of recurrent thromboembolic episodes occurring while on medications.

/pdf/lambl-s-excrescences-current-diagnosis-and-management-1ipn4072ei.pdf

Lambl's Excrescences: Current Diagnosis and Management.

Lambl's excrescences are filamentous extensions of cardiac valves, mostly asymptomatic but rarely associated with catastrophic thromboembolic events such as acute ischemic stroke and acute coronary syndromes. Numerous case reports cited in the literature have addressed various spectrum of presentation of these syndromes and their outcomes based on therapies used. We encountered such a patient from our own experience who presented with an acute ischemic stroke with no other identifiable cause other than the Lambl's excrescences. We subsequently carried out an extensive literature search and based on our interpretation of the outcomes we decided to treat the patient to the best of our understanding. In the proceeding section we describe the case and the discussion and our rationale to treat the patient accordingly.

/pdf/lambl-s-excrescences-a-case-report-and-review-of-the-34trb37gz4.pdf

Lambl's excrescences: A case report and review of the literature.

Stroke / Cerebrovascular accident (CVA) is a leading cause of morbidity and mortality in the world. Ischemic stroke accounts for 87% of the cases, 14-30% of which is attributed to cardio-embolic stroke. Lambl's excrescences (LE) were first described in 1856 by a Bohemian physician- VilemDusanLambl and is considered a rare cause of cardioembolic stroke subtype. LE are branched filiform structures with undulating movements, 1×4-10 mm in size that are usually found on aortic and mitral valves. An atheroma from LE or LE fragments per se may embolize to cerebrovascular arterial territory causing stroke. Multiple isolated cases of stroke associated with LE have been reported in the literature. We hereby report a scoping study of the findings associated with such cases. A total of 27 cases were identified after various scientific databases including PubMed and Google scholar were searched with keywords "lambi's excrescences, stroke, cerebrovascular accidents". Data from these cases were tabulated and analyzed. The mean age at presentation was 51 ± 14.2 (± SD) years with 55% of patient younger than 55 years of age. 56% of cases were males. Transesophageal echocardiogram was more effective in detecting LE when compared to transthoracic echocardiogram. LE were most often found on aortic valve and LE related stroke was most often noted in middle cerebral artery territory. Recurrent stroke was reported in 30%. Management of these cases was highly variable and likely derived from individual experience as LE management guidelines are largely lacking. Single and dual antiplatelet therapy, anticoagulation and valvularsurgery were among the various management strategies employed. We recommend dual antiplatelet after the first episode of CVA related to LE and an antiplatelet in combination with anticoagulation after the second CVA attributed to LE. Also it is reasonable to offer valve replacement after second CVA related to LE as the reccurence rate of CVA is high. Due to rarity in LE reporting and its management a shared decision making has to be made depending on the clinical status of the patient. The formation of a worldwide registry for LE using standardized reporting criteria for the diagnosis with or without incident stroke, would help establish guidelines for the diagnosis and management of this rare, yet serious disease with increased risk of morbidity and mortality.

https://www.graphyonline.com/archives/IJCRT/2018/IJCRT-127/article.pdf

Lambl’s Excrescences and Stroke: A Scoping Study

Background Lambl's excrescences (LE) are fibrous extensions that can be found along the lines of closure of the aortic valve. Due to improvements in ultrasound technology, LE are frequently imaged during transthoracic echocardiography (TTE) in adults. Objective The purpose of this study was to determine the prevalence of LE among children from two eras (2004-2006 and 2011-2012) and the effect of technological advancements on LE detection. Methods TTE from 700 subjects (age 18 years old or younger) were reviewed. All parasternal long and short axis images of the aortic valve were reviewed by a board certified echocardiographer, and the positive studies were then reviewed by two additional observers to confirm the presence of LE. A two-sample t test with 95% significance was used to analyze the presence of LE in the cohorts. Median follow-up duration was 66 months. Results Of the 700 subjects, 12 (1.7%) children were found to have LE. No significant difference in prevalence was found between the two eras (.9% vs. 2.6%, P = .08) and the presence of LE was not related to age (P = .36). The youngest subject with an LE was 5 months old. During long-term follow-up there were no clinical events in the 12 children identified with a LE. Conclusions The prevalence of LE in children is lower than that reported in adults, this supports the age-related "wear and tear" process that has been described in previous studies. LE do not require intervention or more aggressive invasive imaging in children.

Lambl's excrescences in children: Improved detection via transthoracic echocardiography

A 59-year-old man underwent an echocardiography study after myocardial infarction and it showed a thin, mobile mass attached to the aortic valve. A diagnosis of Lambl's excrescence (LE) was suspected. Coronary occlusion as a consequence of embolism of LE's material could not be excluded and the patient underwent surgical excision. Histology confirmed the diagnosis; however a differential diagnosis with papillary fibroelastoma could not be established because both of these structures are histologically indistinguishable. A brief survey of the literature is presented. Evidence-based recommendations for treatment have not been established yet.

https://downloads.hindawi.com/journals/cric/2016/8370212.pdf

Acute Myocardial Infarction in a Patient with Two-Vessel Occlusion and a Large Lambl's Excrescence.

Patient: Female, 51

Final Diagnosis: Transient ischemic attack

Symptoms: Unilateral left-sided weakness and slurred speech

Medication: Lisinopril 20 mg daily

Clinical Procedure: Transesophageal echocardiogram

Specialty: Cardiology • Neurology

Objective:
Rare disease

/pdf/lambl-s-excrescence-associated-with-cryptogenic-stroke-a-4ablgar7nf.pdf

Lambl's Excrescence Associated with Cryptogenic Stroke: A Case Report and Literature Review.

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Lambl's Excrescence Associated with Cryptogenic Stroke: A Case Report and Literature Review.