Nonbacterial thrombotic endocarditis
Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis in which small sterile vegetations are deposited on the valve leaflets. Formerly known as marantic endocarditis, which comes from the Greek marantikos, meaning "wasting away".[1] The term "marantic endocarditis" is still sometimes used to emphasize the association with a wasting state[2] such as cancer.[3]
| Nonbacterial thrombotic endocarditis | |
|---|---|
| Specialty | Cardiology  |
| Treatment | Anticoagulation |
Risk factors
Marantic vegetations are often associated with previous rheumatic fever. Other risk factors include:
- hypercoagulable states
- malignant cancers, especially mucin-producing adenocarcinomas (most commonly associated with pancreatic adenocarcinomas)
- systemic lupus erythematosus: Referred to as Libman-Sacks endocarditis
- trauma (e.g., catheters)
Valve predilection
The disease affects the valves with following predilection: mitral valve > aortic valve > tricuspid valve > pulmonary valve[4]
Histopathology
Grossly, vegetations form along lines of valve closure and are generally symmetric with a smooth or verrucoid (warty) texture. Histologically, lesions are composed of fibrin[5] (eosinophilic) and platelets but, unlike bacterial etiologies, contain little evidence of PMNs, microorganisms or inflammation.
Diagnosis
Due to the non-invasive nature of NBTE, clinical examination may or may not reveal a new murmur. An embolic stroke may be the first feature to suggest diagnosis of NBTE. An echocardiograph may be used to further assess for valvular lesions.
References
- Neurological Sequelae of Infectious Endocarditis at eMedicine
- "Noninfective Endocarditis: Endocarditis: Merck Manual Professional". Retrieved 2008-12-22.
- "Marantic endocarditis". Online Medical Dictionary. Retrieved 2008-12-22.
- "UpToDate".
- "nonbacterial thrombotic endocarditis" at Dorland's Medical Dictionary