Lambl's Excrescences (Valvular Strands)

We review the literature on Lambl's excrescences (valvular strands). With the widespread use of cardiac imaging modalities, most importantly, with transesophageal echocardiography, abnormal valvular structures are frequently identified on both native and prosthetic heart valves. However, there is no consensus in the literature on the correct terminology of these structures. The relationship between valvular strands (the so-called Lambl's excrescences) and papillary fibroelastomas has not been well established. In this review, we attempt to summarize the available echocardiographic descriptors and the gross macroscopic and histological features of Lambl's excrescences (valvular strands). In addition, we review the etiology, pathogenesis, and clinical implications of these cardiac excrescences. Also, we describe features that help to distinguish between Lambl's excrescences and papillary fibroelastomas. Because valvular strands (Lambl's excrescences) have been implicated in systemic thromboembolism, we also review the available management principles for patients with valvular strands; unfortunately, no specific therapeutic guidelines can be proposed at the present time.