Nonbacterial thrombotic endocarditis: A review

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Abstract

The entity of NBTE is reviewed in this article. Historic aspects, epidemiology, and pathogenesis are discussed. The clinicopathologic findings are emphasized as well as the potential for antemortem diagnosis and therapy. NBTE is diagnosed infrequently before death. Clinical suspicion is aroused in patients with an underlying process such as malignancy, DIC, or a spectrum of other diseases and evidence of pulmonary and/or systemic embolization. Systemic infaction must be excluded. Two-dimensional echocardiography can be utilized to confirm the diagnosis. Anticoagulation therapy with heparin may prevent embolization.

References (113)

  • AO Fayemi et al.

    Nonbacterial thrombotic endocarditis and myocardial infarction

    Am Heart J

    (1979)
  • JC Dillon et al.

    Echocardiographic manifestations of valvular vegetations

    Am Heart J

    (1973)
  • BA Olney et al.

    The consequences of the inconsequential: marantic (nonbacterial thrombotic) endocarditis

  • CM Estevez et al.

    Serial echocardiographic abnormalities in nonbacterial thrombotic endocarditis of the mitral valve

    Chest

    (1976)
  • RJ Siegel et al.

    Marantic endocarditis. Diagnosis by 2-D echocardiography

    Chest

    (1981)
  • R Zeigler

    Uber den bau die entstehung endocaritischer efflorescenzen. Werh Dtsch Kong

    Intern Med

    (1888)
  • F Harbitz

    Studen uber endocarditis

    Dtsch Med Wochenschr

    (1899)
  • E Libman

    Characterization of various forms of endocarditis

    JAMA

    (1923)
  • L Gross et al.

    Nonbacterial thrombotic endocarditis. Classification and general description

    Arch Intern Med

    (1936)
  • AC Allen et al.

    The morphogenesis and significance of degenerative verrucal endocardiosis (terminal endocarditis, endocarditis simplex, nonbacterial thrombotic endocarditis

    Am J Pathol

    (1944)
  • A Angrist et al.

    The changing morphologic picture of endocarditis since the advent of chemotherapy and antibiotic agents

    Am J Pathol

    (1954)
  • RA MacDonald et al.

    The significance of nonbacterial thrombotic endocarditis: an autopsy and clinical study of 78 cases

    Ann Intern Med

    (1957)
  • KD Barron et al.

    Cerebral embolism caused by nonbacterial thrombotic endocarditis

    Neurology

    (1960)
  • RF Rohner et al.

    Mucinous malignancies, venous thrombosis and terminal endocarditis with emboli: a syndrome

    Cancer

    (1966)
  • M Eliakim et al.

    Degenerative verrucous endocardiosis. A clinical-pathologic study of 45 cases with reference to a protracted form of the disease

    Isr J Med Sci

    (1966)
  • P Rosen et al.

    Nonbacterial thrombotic endocarditis in patients with malignant neoplastic disease

    Am J Med

    (1973)
  • H-S Kim et al.

    Nonbacterial thrombotic endocarditis (NBTE) and disseminated intravascular coagulation (DIC). Autopsy study of 36 patients

    Arch Path Lab Med

    (1977)
  • A Bedikian et al.

    Nonbacterial thrombotic endocarditis in cancer patients: comparison of characteristics of patients with and without concomitant disseminated intravascular coagulation

    Med Pediatr Oncol

    (1978)
  • J Biller et al.

    Nonbacterial thrombotic endocarditis. A neurologic perspective of clinicopathologic correlations of 99 patients

    Arch Neurol

    (1982)
  • T Miksanek

    Nonbacterial thrombotic endocarditis

    Am Fam Physician

    (1983)
  • K Kuramoto et al.

    Nonbacterial thrombotic endocarditis as a cause of cerebral and myocardial infarction

    Jpn Circ J

    (1984)
  • JC Kooiker et al.

    Cerebral embolism, marantic endocarditis and cancer

    Arch Neurol

    (1976)
  • BH Liwnicz et al.

    Nonbacterial thrombotic endocarditis in premature child. Clinical significance and possible relationships to subvalvular hematoma

    NY State J Med

    (1976)
  • RH McDonald

    Valvular thrombotic vegetation in newborn (“fetal endocarditis”)

    Arch Pathol

    (1950)
  • HF Krous

    Neonatal nonbacterial thrombotic endocarditis

    Arch Pathol Lab Med

    (1979)
  • RSK Young et al.

    Marantic endocarditis in children and young adults: clinical and pathologic findings

    Stroke

    (1981)
  • AM Tsanaclis et al.

    Cerebral embolism in nonbacterial thrombotic endocarditis associated with carcinoma. A clinico-pathologic study

    Acta Neurol Latinoam

    (1976)
  • WE Barry et al.

    Nonbacterial thrombotic endocarditis. A clinicopathologic study

    Arch Neurol Med

    (1962)
  • BF Waller et al.

    Marantic valvular vegetations

    Circulation

    (1973)
  • SJ Rabboy et al.

    Pathology of disseminated intravascular coagulation. Analysis of 26 cases

    Hum Pathol

    (1972)
  • SH Goodnight

    Bleeding and intravascular clotting in malignancy: a review

    Am NY Acad Sci

    (1974)
  • M Sugiura et al.

    A clinicopathological study on cardiac lesions in 64 cases of disseminated intravascular coagulation

    Jpn Heart J

    (1977)
  • M Ehrie et al.

    Endocarditis with indwelling balloon-tipped pulmonary artery catheter in burn patients

    J Trauma

    (1978)
  • A Angrist et al.

    Vegetative endocarditis

    Pathol Annu

    (1967)
  • AA Angrist et al.

    Studies in experimental endocarditis. I. Production of valvular lesions by mechanisms not involving infection or sensitivity factors

    Am J Pathol

    (1960)
  • M Oka et al.

    Experimental endocarditis

    Rev Can Biol

    (1963)
  • M Oka et al.

    Histochemical studies of thrombotic nonbacterial endocarditis

    Laboratory Investigation

    (1964)
  • JF Rinehart et al.

    Heart valves and muscle in experimental scurvy with superimposed infection with notes on similarity of lesions to those of rheumatic fever

    Am J Pathol

    (1964)
  • A Angrist et al.

    Aging heart valves and a unitary pathological hypothesis for sclerosis

    J Gerontol

    (1966)
  • A Pomerance

    Pathogenesis of “senile” nodular sclerosis of atrioventricular valves

    Br Heart J

    (1967)

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