A MOBILE MASS ON THE AORTIC VALVE

Abstract

TYPE: Late Breaking Case Report TOPIC: Cardiovascular Disease INTRODUCTION: Marantic endocarditis, also called Nonbacterial Thrombotic Endocarditis (NBTE), is a condition immune mediated condition that signifies noninfectious lesions or vegetations to the endocardium. CASE PRESENTATION: 68-year-old female with past medical history of homozygous MTHFR C677T mutation with normal homocysteine, spontaneous deep vein thrombosis and pulmonary embolism, status post IVC filter on anticoagulation therapy was seen for evaluation of tachycardia. She is found to have atrial fibrillation with rapid ventricular response of 148 bpm. Transthoracic echocardiogram (TTE) and subsequent trans-esophageal echo (TEE) showed large vegetation (15mmx12mm) with mobile components on the aortic valve and severe aortic insufficiency (AI). The patient remained afebrile throughout the evaluation and had several negative blood cultures without antibiotics. Laboratory values showed no elevation in white blood cell count and mild elevation in erythrocyte sedimentation rate and C-reactive protein. Patient was evaluated for surgical intervention and was found having extensive periodontitis which required extraction of her lower jaw teeth. The patient eventually had a successful surgical aortic valve replacement. The final pathology revealed a dystrophic calcifications, some neutrophils and abundant fibrin deposition but no bacteria on specimen culture. DISCUSSION: Murantic endocarditis does not frequently present with fever, and was an incidental finding in this case. The relatively rare neutrophils seen within the thrombotic vegetation by pathology sample were felt to represent entrapped peripheral blood elements rather than evidence of a host inflammatory response. CONCLUSIONS: Overall, the features are favored to represent NBTE, a conclusion supported by the patient's serially negative blood cultures and negative tissue cultures on the valve specimen. DISCLOSURE: Nothing to declare. KEYWORD: Vegitations,Murantic endocarditis, thrombotic, aortic valve