Lambl's excrescences

I was told last March after a TEE that a Lambl's Excresence was found on my aortic valve.  I was having and still have periodic irregular heart beat.  The Cardiologist said it was small and it was nothing to worry about.  But after reading on the internet, I see that it can cause strokes and other problems and should be closely monitored.My family doctor got the results and same as the cardiologist doesn't seem to think it is a big deal.I do.I just don't feel right. Fatigue and I mean really tired alot of the time. LIght headedness. Achiness in center of chest. Not severe at all but there at times in a mild way. I get so fatigued that I can't even concentrate. Have had other tests all good. Blood work etc. But I can't help but wonder if that is causing my problem. I also had a stress echo that they said was good. Because my stupid insurance would not cover a regular stress test. This alarms me. How would I even know until I have a heart attack if I would need to have a catheterization done if they won't pay to have the REAL COMPLETE tests done. My husband even passed his stress test with a 90% artery blockage that would not have been found if his doctor hadn't pressed for it. But alas , he has better insurance than I do. Should I be concerned about this Lambls thing?

Hi Mary Lou,
I agree with you. If true, Lambl's excrescences (LE) are small blood clots on the margins of heart valves  where the valve leaflets make contact. They are caused by minor damage due to wear and tear. Most patients with LE are asymptomatic. However, LE — found mostly on aortic valve leaflets — can break apart and get into your circulation (embolize). When they embolize to the brain, they can cause a stroke. Asymptomatic patients with evidence of Lambl's excrescences should be monitored closely with serial echocardiograms. If there is evidence of a stroke in a patient with Lambl's excrescences, anticoagulation is advised and operative removal of Lambl's excrescences should be considered.
However, your other symptoms of fatigue don't have anything to do with this, although they may be suggestive of heart disease. A stress echo is usually more than adequate to demonstrate coronary artery disease and the treatment of a severe blockage (like with your husband) doesn't necessarily need treatment with a stent or bypass surgery. Often "optimal medical therapy" is just as effective!

Hope this helps,
Dr T


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