https://doi.org/10.4081/monaldi.2023.2729
Multi-valve Libman-Sacks’s endocarditis-related multiple, massive and fatal systemic embolization. A case report and a review of diagnostic work-up
Submitted: July 23, 2023
Accepted: September 3, 2023
Published: October 9, 2023
Accepted: September 3, 2023
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Video 1: 66
Video 2: 58
Video 3: 61
Video 4: 64
Video 5: 58
Video 6: 63
Video 7: 68
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
We reported a case of non-bacterial thrombotic endocarditis (NBTE) in a 37-year-old woman who presented with signs and symptoms of cardio-embolic cerebral stroke caused by a prothrombotic state due to underlying advanced uterine cancer. Multimodal imaging, including 3D-ecocardiography, as well as laboratory and cultural tests, were critical in making the diagnosis. After starting anticoagulation therapy with low molecular weight heparin (LMWH), the patient underwent surgical aortic valve replacement due to worsening aortic valve function, initial left ventricle enlargement, increasing dimensions, and mobility of vegetations. Unfortunately, vegetations relapsed on the aortic valve bio-prosthesis as well as the mitral leaflets, resulting in a final picture of multi-valve NBTE. The fatal outcome was due to a massive multiple limb embolism, which resulted in leg amputations and septical complications. Starting with the case, we present a brief overview of the pathology's presentation, treatment, management, and prognosis, as well as the diagnostic work-up.
Baglin T, Gray E, Greaves M, et al. Clinical guidelines for testing for heritable thrombophilia. Br J Haematol 2010;149:209-20.
Rodriguez EA, Choudhry MW, Boor PJ, et al. Primary nonbacterial thrombotic endocarditis presenting with bowel infarction secondary to superior mesenteric artery embolism. Methodist Debakey Cardiovasc J 2018;14:228.
DOI: https://doi.org/10.14797/mdcj-14-3-228
Venepally NR, Arsanjani R, Agasthi P, et al. A new insight into nonbacterial thrombotic endocarditis: a systematic review of cases. Anatol J Cardiol 2022;26:743.
DOI: https://doi.org/10.5152/AnatolJCardiol.2022.1282
Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075-123.
DOI: https://doi.org/10.1093/eurheartj/ehv319
Smeglin A, Ansari M, Skali H, et al. Marantic endocarditis and disseminated intravascular coagulation with systemic emboli in presentation of pancreatic cancer. J Clin Oncol 2008;26:1383-5.
DOI: https://doi.org/10.1200/JCO.2007.12.9148
el-Shami K, Griffiths E, Streiff M. Nonbacterial thrombotic endocarditis in cancer patients: pathogenesis, diagnosis, and treatment. Oncologist 2007;12:518-23.
DOI: https://doi.org/10.1634/theoncologist.12-5-518
Edoute Y, Haim N, Rinkevich D, et al. Cardiac valvular vegetations in cancer patients: a prospective echocardiographic study of 200 patients. Am J Med 1997;102:252-8.
DOI: https://doi.org/10.1016/S0002-9343(96)00457-3
Deppisch LM, Olusegun Fayemi A. Non-bacterial thrombotic endocarditis: clinicopathologic correlations. Am Heart J 1976;92:723-9.
DOI: https://doi.org/10.1016/S0002-8703(76)80008-7
Rosen P, Armstrong D. Nonbacterial thrombotic endocarditis in patients with malignant neoplastic diseases. Am J Med 1973;54:23-9.
DOI: https://doi.org/10.1016/0002-9343(73)90079-X
Eiken PW, Edwards WD, Tazelaar HD, Zehr KJ. Surgical pathology of nonbacterial thrombotic endocarditis in 30 patients, 1985-2000. Mayo Clin Proc 2001;76:1204-12.
DOI: https://doi.org/10.4065/76.12.1204
Llenas-García J, Guerra-Vales JM, Montes-Moreno S, et al. [Nonbacterial thrombotic endocarditis: clinicopathologic study of a necropsy series].[Article in Spanish]. Rev Esp Cardiol 2007;60:493-500.
DOI: https://doi.org/10.1016/S1885-5857(07)60190-X
Steiner I. [Nonbacterial thrombotic endocarditis--a study of 171 case reports].[Article in Czech]. Cesk Patol 1993;29:58-60.
González Quintela A, Candela MJ, et al. Non-bacterial thrombotic endocarditis in cancer patients. Acta Cardiol 1991;46:1-9.
Mazokopakis EE, Syros PK, Starakis IK. Nonbacterial thrombotic endocarditis (marantic endocarditis) in cancer patients. Cardiovasc Hematol Disord Drug Targets 2010;10:84-6.
DOI: https://doi.org/10.2174/187152910791292484
Baglin T, Gray E, Greaves M, et al. Clinical guidelines for testing for heritable thrombophilia. Br J Haematol 2010;149:209-20.
DOI: https://doi.org/10.1111/j.1365-2141.2009.08022.x
Piccioli A, Lensing AWA, Prins MH, et al. Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial. J Thromb Haemost 2004;2:884-9.
DOI: https://doi.org/10.1111/j.1538-7836.2004.00720.x
Zmaili MA, Alzubi JM, Kocyigit D, et al. A contemporary 20-year Cleveland Clinic experience of nonbacterial thrombotic endocarditis: etiology, echocardiographic imaging, management, and outcomes. Am J Med 2021;134:361-9.
DOI: https://doi.org/10.1016/j.amjmed.2020.06.047
Silbiger JJ. The valvulopathy of non-bacterial thrombotic endocarditis. J Heart Valve Dis 2009;18:159-66.
Roldan CA, Tolstrup K, Macias L, et al. Libman-Sacks endocarditis: detection, characterization, and clinical correlates by three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 2015;28:770-9.
DOI: https://doi.org/10.1016/j.echo.2015.02.011
Galzerano D, Kinsara AJ, Di Michele S, et al. Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging? Int J Cardiovasc Imaging 2020;36:403-13.
DOI: https://doi.org/10.1007/s10554-019-01747-x
Lopez JA, Ross RS, Fishbein MC, Siegel RJ. Nonbacterial thrombotic endocarditis: a review. Am Heart J 1987;113:773-84.
DOI: https://doi.org/10.1016/0002-8703(87)90719-8
Whitlock RP, Sun JC, Fremes SE, et al. Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e576S-e600S.
DOI: https://doi.org/10.1378/chest.11-2305
Rogers LR, Cho ES, Kempin S, Posner JB. Cerebral infarction from non-bacterial thrombotic endocarditis. Clinical and pathological study including the effects of anticoagulation. Am J Med 1987;83:746-56.
DOI: https://doi.org/10.1016/0002-9343(87)90908-9
Yokoyama S, Iwano H, Yamada S, et al. Long-term echocardiographic evaluation of valvular lesions in a patient with nonbacterial thrombotic endocarditis associated with advanced uterine cancer. J Cardiol Cases 2016;14:82-6.
DOI: https://doi.org/10.1016/j.jccase.2016.04.005
How to Cite
Parato, Vito Maurizio, Sara Belleggia, Andrea Giovanni Parato, Umberto Ianni, Michela Molisana, Germana Gizzi, Simone D’Agostino, Melissa Dottori, and Marco Di Eusanio. 2023. “Multi-Valve Libman-Sacks’s Endocarditis-Related Multiple, Massive and Fatal Systemic Embolization. A Case Report and a Review of Diagnostic Work-up”. Monaldi Archives for Chest Disease, October. https://doi.org/10.4081/monaldi.2023.2729.
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