Echocardiographic diagnosis of aortic valve strands: case series and literature review. (4th February 2022)

• Record Type: Journal Article
• Authors: Garcia Olea, A; Ramirez-Escudero Ugalde, G; Maeztu Rada, M; Garcia Ibarrondo, N; Codina Prat, M; Manzanal Rey, A; Asla Ormaza, C; Ruiz Gomez, L
• Is Part Of: European heart journal. Volume 23(2022)Supplement 1
• Publication Date: 2022-02-04
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeab289.201
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Introduction. Aortic valve Lambl's excrescences (LE) were first described as histopathological findings in 1856. Since then, most research on these structures consist of case reports and studies conducted to elucidate their thrombogenic role. Indeed, their nomenclature has differed on time, receiving names such as fibrous bands or strands, so features of patients with these conformations remain imprecise. Purpose. To elucidate the demographic characteristics of patients with aortic valve strands detected by echocardiography. Methods. We conducted a literature review in MEDLINE database for studies on aortic valve fibrous bands, strands or LE on humans, with no date restrictions and full text filter. Papillary fibroelastoma was not included in the search according to the histological differences of this neoformation. We screened these articles and removed incorrect matches, studies that did not differentiate between mitral and aortic strands and those which lacked an echocardiographic diagnosis. We added the cases of patients with aortic valve strand label in our laboratory database. Demographic variables present in the studies were extracted, summarized in a table and analyzed with descriptive statistics. Results. The literature review disclosed 97 studies, out of which 53 fulfilled the inclusion criteria. The most common exclusion reasons were histopathological instead of echocardiographic diagnosis and absence of information of the LE location. A case series of 3 patients from our laboratory was added. Among the 560 cases of strands, aortic native valves (278, 49.6%) were more affected than prosthetic ones (68, 12%), most without predisposing valvular disease. Reports in women were similar to those in men (272 vs 259), and most registries showed a balanced gender proportion. The weighted mean age was around 54 years old, although strands were also found in newborns and 80-year-old men. The etiological study of cryptogenic stroke was, in most cases, the reason for the diagnostic echocardiogram performance (149, 26.6%), followed by endocarditis suspicion (46, 8.2%), while the studies conducted to assess aortic regurgitation or stenosis causes were predominant in case reports. The terms "strands" and "LE" were equally used in the studies on aortic fibrous bands. Conclusion. Current evidence suggests that aortic valve strands are predominant in middle-age men or women with healthy native valves, especially in those patients whose echocardiography is performed searching for thrombogenic causes or endocarditis. Further prospective studies with a selective focus on LE search would help to precisely define the demographic features of patients presenting these structures.