Abstract
Non-bacterial thrombotic endocarditis (NBTE) is a rare condition, but is frequently under- estimated, probably due to the underlying disease (cancer, autoimmune disorders, HIV). The diagnosis of NBTE relies on strong clinical suspicion in the context of (1) a disease process known to be associated with NBTE, (2) the presence of a heart murmur, (3) negative blood culture, (4) the presence of vegetations not responding to antibiotic treatment, and (5) evidence of multiple systemic emboli. The management of NBTE is challenging and a tailored approach should be advocated. It should first focus on the underlying pathology. In the absence of contraindication, an anticoagulation treatment should be given. Surgical intervention is not recommended unless the patient has clear indications (i.e., heart failure due to valve dysfunction).
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References
Lopez JA, Ross RS, Fishbein MC. Nonbacterial thrombotic endocarditis. A review. Am Heart J. 1987;113:773–84.
Gross L, Friedberg CK. Nonbacterial thrombotic endocarditis. Classification and general description. Arch Intern Med. 1936;58:620–40.
Libman E, Sacks B. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med. 1924;33:701–37.
Silbiger JJ. The valvulopathy of non-bacterial thrombotic endocarditis. J Heart Valve Dis. 2009;18:159–66.
Eiken PW, Edwards WD, Tazelaar HD, et al. Surgical pathology of nonbacterial thrombotic endocarditis in 30 patients, 1985–2000. Mayo Clin Proc. 2001;76:1204.
El-Shami K, Griffiths E, Streiff M. Nonbacterial thrombotic endocarditis in cancer patients: pathogenesis, diagnosis, and treatment. Oncologist. 2007;12:518.
Borowski A, Ghodsizad A, Cohnen M, Gams E. Recurrent embolism in the course of marantic endocarditis. Ann Thorac Surg. 2005;79:2145–7.
Habib G, Cohen P, Milandre L, Gayraud D, Giuliani P, Harlé JR, Scheiner C, Casalta JP, Ferracci A, Luccioni R. Non bacterial thrombotic endocarditis (marantic endocarditis). Apropos of a case and value of transoesophageal echocardiography. Arch Mal Coeur Vaiss. 1996;89:261–4.
Roldan CA, Shively BK, Crawford MH. An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. N Engl J Med. 1996;335:1424.
Fournier PE, Thuny F, Richet H, Lepidi H, Casalta JP, Arzouni JP, Maurin M, Célard M, Mainardi JL, Caus T, Collart F, Habib G, Raoult D. Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis. 2010;51:131–40.
Mazokopakis EE, Syros PK, Starakis IK. Nonbacterial thrombotic endocarditis (marantic endocarditis) in cancer patients. Cardiovasc Hematol Disord Drug Targets. 2010;10:84–6.
Moore JE, Millar BC, Yongmin X, Woodford N, Vincent S, Goldsmith CE, McClurg RB, Crowe M, Hone R, Murphy PG. A rapid molecular assay for the detection of antibiotic resistance determinants in cause of infective endocarditis. J Appl Microbiol. 2001;90:719–26.
Lisnevskaia L, Murphy G, Isenberg D. Systemic lupus erythematosus. Lancet. 2014;384:1878–88.
Asopa S, Patel A, Khan OA, Sharma R, Ohri SK. Non-bacterial thrombotic endocarditis. Eur J Cardiothorac Surg. 2007;32:696–701.
Reisner SA, Brenner B, Haim N, Edoute Y, Markiewicz W. Echocardiography in nonbacterial thrombotic endocarditis: from autopsy to clinical entity. J Am Soc Echocardiogr. 2000;13:876–81.
Roldan CA, Qualls CR, Sopko KS, Sibbitt Jr WL. Transthoracic versus transesophageal echocardiography for detection of Libman-Sacks endocarditis: a randomized controlled study. J Rheumatol. 2008;35:224–9.
Roldan CA, Tolstrup K, Macias L, Qualls CR, Maynard D, Charlton G, Sibbitt WL Jr. J Am Soc Echocardiogr. 2015;28(7):770–9.
Dutta T, Karas MG, Segal AZ, Kizer JR. Yield of transesophageal echocardiography for nonbacterial thrombotic endocarditis and other cardiac sources of embolism in cancer patients with cerebral ischemia. Am J Cardiol. 2006;97:894–8.
Edoute Y, Haim N, Rinkevich D, Brenner B, Reisner SA. Cardiac valvular vegetations in cancer patients: a prospective echocardiographic study of 200 patients. Am J Med. 1997;102:252–8.
Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med. 2007;120:636–42.
Salem DN, Stein PD, Al-Ahmad A, Bussey HI, Horstkotte D, Miller N, Pauker SG. Antithrombotic therapy in valvular heart disease – native and prosthetic: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126:457S–82.
Giles I, Khamashta M, D’Cruz D, Cohen H. A new dawn of anticoagulation for patients with antiphospholipid syndrome? Lupus. 2012;21:1263–5.
Dandekar UP, Watkin R, Chandra N, Santo KC, Bhudia S, Pitt M, et al. Aortic valve replacement for Libman-Sacks endocarditis. Ann Thorac Surg. 2009;88:669–71.
Habig G, Lancellotti P, Antunes MJ, et al. ESC 2015 guidelines on the management of infective endocarditis. Eur Heart J. 2015;36(44):3075–128.
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Lancellotti, P. (2016). Non-bacterial Thrombotic Endocarditis. In: Habib, G. (eds) Infective Endocarditis. Springer, Cham. https://doi.org/10.1007/978-3-319-32432-6_16
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DOI: https://doi.org/10.1007/978-3-319-32432-6_16
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