Lambl's Excrescences Aortic Valve, Echo, Stroke, Treatment

What is Lambl's Excrescences

Lambl's Excrescences are an uncommon form of cardiac growth that can appear at the valve coaptation sites of the heart. These growths can be identified on echocardiography as narrow, hypermobile, and filiform strands. The term "excrescence" comes from the field of histology. When these filiform strands break off and embolize to peripheral tissues, they can cause major consequences including embolic stroke or acute coronary syndromes, which can be detected on an echocardiogram inadvertently or in conjunction with abnormalities. 

Lambl's Excrescences Aortic Valve

The exact pathogenesis is unclear. The two valves where Lambl's excrescences are most frequently found are mitral and aortic. When compared to mitral valves, ischemic events were, however, more frequently associated with those on aortic valves. The endocardium is thought to occasionally rip as a result of the high stress brought on by blood flow jets that cause trauma and shearing pressures on the heart valves. These tears take place on the valve cusps at the coaptation site and are then followed by fibrin deposition and the production of tiny thrombi in response to endothelial damage, which is then followed by an overgrowth of endothelium over an extended period of time with increasing age.

The presence of Lambl's excrescences can be observed in both children and adults. The incidence, on the other hand, is more common in older people than in children and rises with advancing age. On echocardiography, the prevalence reaches its highest point between the ages of 61 and 70, after which it begins to decline. This is because, as people age, their heart valves become increasingly calcified, which leads to an underdetection. Additionally, men are more likely to experience it than women. Lambl's excrescences are found to appear on all natural and artificial valves, however, their incidence is higher on the left-sided heart valves, particularly the aortic valve rather than the mitral valve. When asymptomatic Lambl's excrescences are monitored for an extended period of time, they don't seem to undergo any noticeable morphological changes over time.

Lambl's Excrescences Echo

Lambl's excrescences are small, raised lesions that commonly form on the mitral valve. They are echo–lucent and typically have a pedunculated appearance. Lambl's excrescences are thought to represent areas of myxomatous degeneration within the valve tissue. Although they are generally asymptomatic, they can potentially lead to valvular dysfunction if large enough. echo of Lambl's Excrescences is therefore an important finding to be aware of when assessing the mitral valve.

Lambl's Excrescences Stroke

The majority of people who have Lambl's excrescences do not experience any symptoms and the condition is discovered by chance during an echocardiogram or during an autopsy. These, particularly when detected on aortic valve cusps, have an increased risk of breaking off and embolizing to distal organs, frequently in connection with embolic strokes, arterial embolisms resulting in acute coronary disorders, or cardiopulmonary embolism  If they are big enough, even in the absence of embolization, they might induce a mechanical obstruction of the valvular tissue. Patients who are impacted by the condition may exhibit a wide variety of neurological and cardiac symptoms, depending on the target distal organ.

Lambl's Excrescences Treatment

For the management of Lambl's excrescences, there are no precise, evidence-based recommendations. The treatment strategy is mostly derived from cases that have been documented in relevant medical journals. The treatment of Lambl's excrescences has been described using a variety of methods, some of which are pharmacological and others of which are surgical. The best way to treat asymptomatic people is with close monitoring and repeated echocardiograms. 

Always perform a thorough stroke workup to detect any probable causes of stroke when they are present. In addition to a comprehensive transesophageal echocardiogram exam that evaluates the transverse, ascending, and arch portions of the aorta, this should also include carotid duplex ultrasonography and a hypercoagulable workup. Patients may be treated with medications (antiplatelet drugs) like clopidogrel, and aspirin as well as anticoagulant like warfarin if the workup is still negative and there is no obvious explanation. Surgical excision may be helpful in situations of repeated strokes when Lambl's excrescences are involved and are present.