Original ArticleSurgical Pathology of Nonbacterial Thrombotic Endocarditis in 30 Patients, 1985–2000
Section snippets
PATIENTS AND METHODS
Cases were identified by a manual search of all the surgical pathology reports for cardiac valve specimens removed between January 1, 1985, and December 31, 2000, at Mayo Clinic, Rochester, Minn. Patients were included based on a histological diagnosis of NBTE, noninfectious thrombotic endocarditis, Libman-Sacks endocarditis, marantic endocarditis, or verrucous endocarditis or a description in the pathology report of thrombus or sterile vegetation involving 1 or more heart valves. Patients with
Patient Demographics
The study group consisted of 20 female and 10 male patients (32 valves). The age range was 15 to 89 years, with a mean of 49 years. Female patients were younger than male patients (mean, 43 vs 59 years, respectively). The New York Heart Association functional state was class III or higher in 14 (47%) of all patients and in 11 women (55%) and 3 men (30%) (Table 1).
Among the 30 patients, the mitral valve was affected in 21 (70%) and the aortic valve in 10 (33%) (2 patients had both mitral and
Definition of Valvular Vegetations
Valvular vegetations may be infected or noninfected. Traditionally, noninfected vegetations have been categorized as acute rheumatic endocarditis, Libman-Sacks endocarditis, or NBTE.6 Although some investigators have limited NBTE to vegetations that are grossly visible on otherwise normal valves, this approach provides no diagnostic category for bland valvular thrombi that are small or involve diseased valves. Recognizing this issue and the overlap between some cases of Libman-Sacks
CONCLUSIONS
In a surgical population, NBTE is most commonly associated with autoimmune and connective tissue disorders, in contrast to disseminated malignancy reported in autopsy series. Regardless of the underlying etiology, the vegetations have a uniform appearance and seem to be similar with respect to both valve dysfunction and embolization. An ante-mortem diagnosis of NBTE in a patient with no known risk factors should prompt a search not only for occult malignancy, as suggested by autopsy studies,
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2021, American Journal of MedicineCitation Excerpt :Table 5 compares baseline characteristics with regards to survival status at follow-up. The true incidence of nonbacterial thrombotic endocarditis is still unknown, and much of the available evidence regarding its prevalence is derived from autopsy series.1,8-10,14-16 Patients with nonbacterial thrombotic endocarditis are often asymptomatic, but can present with systemic embolization, a phenomenon that occurs in up to 50% of patients and can be devastating, depending on the site involved.17
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2021, Handbook of Clinical NeurologyCitation Excerpt :Acute cell injury in the setting of underlying predisposing autoimmune, paraneoplastic, or prothrombotic condition may lead to endothelial cell damage and deposition of sterile platelets and strands of fibrin on the heart valve leaflets. In malignancies, migrating inflammatory mononuclear cells interact with cancer cells, releasing cytokines, leading to further endothelial injury, and promoting platelets deposition (Eiken et al., 2001; el-Shami et al., 2007). The presence of chronic immune complex or antiphospholipid antibodies may accelerate endothelial injury and thus may promote thrombus formation (Moyssakis et al., 2007).
Presented as an abstract at the American Heart Association scientific sessions, Anaheim, Calif, November 12, 2001.