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Case Reports
. 2019 Sep 25;1(3):350-354.
doi: 10.1016/j.jaccas.2019.07.026. eCollection 2019 Oct.

Quadravalvular Noninfectious Endocarditis

Peter P Vlismas  1 , Jonas J Heymann  2 , Charles C Marboe  3 , Ulrich P Jorde  1 , Daniel B Sims  1
Affiliations
Case Reports

Quadravalvular Noninfectious Endocarditis

Peter P Vlismas et al. JACC Case Rep. .

Abstract

Nonbacterial thrombotic endocarditis is characterized by sterile thrombi on cardiac valves. This report describes the case of nonbacterial endocarditis without pathologic findings of fibrin or platelet deposition. Quadrivalvular endocarditis was found to be due to immunoglobulin M heavy chain deposition. This was a case of nonbacterial, nonthrombotic quadrivalvular endocarditis, which was termed noninfective endocarditis. (Level of Difficulty: Intermediate.).

Keywords: AV, atrioventricular; B-cell lymphoproliferative disorder; LAD, left anterior descending coronary artery; LHCDD, light and heavy chain deposition disease; NBTE, Nonbacterial thrombotic endocarditis; NIE, noninfective endocarditis; nonbacterial thrombotic endocarditis; noninfective endocarditis.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Transthoracic and Transesophageal Echocardiogram (A) TTE, parasternal long axis view of aortic (white arrow) and mitral valve vegetations (green arrow). (B) TTE, parasternal right ventricular inflow view of tricuspid valve vegetations. (C) TTE, parasternal right ventricular outflow view of pulmonary valve vegetations. (D) TEE, aortic (green arrow) and mitral valve vegetations (white arrow). (E) TEE, mitral valve vegetations. (F) TEE, fungating mass in the left atrial appendage. See Videos 1, 2, 3, and 4. TEE = transesophageal echocardiogram; TTE = transthoracic echocardiogram.
Figure 2
Figure 2
Coronary CT Angiography CT angiography of the left anterior descending artery with mixed calcific and soft plaque with 50% to 70% stenosis (A) and the right coronary artery with soft plaque and subtotal occlusion (B). CT = computed tomography.
Figure 3
Figure 3
Pathology Vegetations found on the aortic valve (A), tricuspid valve (B), pulmonary valve (C), and left atrial appendage with fungating mass (D).
Figure 4
Figure 4
Aortic Valve Vegetation Hematoxylin and eosin stain of the aortic valve with IgM deposition. *Vegetation consisting of IgM.
Figure 5
Figure 5
Left Anterior Descending Coronary Artery Occlusion Hematoxylin and eosin stain of the LAD with complete occlusion by atherosclerotic plaque and IgM embolism. *IgM embolism. AF= adventitial fat; CAW = coronary artery wall; LAD = left anterior descending artery.
Figure 6
Figure 6
Immunofluorescence Immunofluorescence performed on the kidney, used to confirm IgM.
See this image and copyright information in PMC

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