Non-Bacterial Aortic Valve Vegetation

Abstract

A year-old man was referred to our hospital for management of a 2 cm × 2.3 cm lesion seen on the left coronary cusp of his aortic valve on transoesophageal echocardiogram (Fig. 1, panel A and B). There was a mild gradient across the aortic valve (mean gradient of 17 mm Hg) and some mild eccentric aortic regugitation as a consequence of the lesion. Echocardiography had been performed after an ejection systolic murmur was noted by his local medical officer. He denied symptoms of infection or congestive cardiac failure. Routine initial endocarditis. Anti cardiolipin IgG antibodies were detected and anti2-glycoprotein antibodies had a titre of >100 U/ml. He underwent computed tomography (CT) to search for embolic sequelae of the antiphospholipid syndrome. CT abdomen revealed a 12 cm × 4.4 cm × 6 cm splenic infarct. CT brain identified two areas of established encephalomalacia consistent with past embolic stroke. There were no other features to suggest systemic lupus erythematous. Repeat antiphospholipid antibodies remained markedly elevated three months after preseninvestigations were unremarkable. Multiple sets of blood cultures were negative. Urgent antiphospholipid antibodies were ordered given the clinical suspicion of marantic tation. He is being treated with lifelong warfarin and remains asymptomatic. There has been no change in the size of the lesion on a repeat echocardiogram.