Nonbacterial Thrombotic Endocarditis of the Aortic Valve in a Patient With Antiphospholipid Syndrome

Figures

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  Figure 1. ECG on Admission Electrocardiography at admission, showing signs of left ventricular hypertrophy (high QRS voltages in precordial leads) and negative T-wave inversion predominantly in the inferior and lateral leads.

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  Figure 2. Transesophageal Echocardiography Transesophageal echocardiography showing diffuse thickening of the aortic valve, particularly evident in the noncoronary and left coronary cusps, observed in the 130° and 45° mid-esophageal views (A and C, respectively). (B) Eccentric mild to moderate aortic regurgitation is visualized by color Doppler in the 130° mid-esophageal view, (D) and severe aortic stenosis is depicted by continuous Doppler signal in a transgastric 5-chamber view.

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  Figure 3. Helicoidal Cardiac Computed Tomographic Scan (A and B) Significant thickening of the aortic valve depicted in the 3-chamber and short-axis views, respectively. (C) Three-dimensional volume rendering of the aorta and aortic root demonstrating aortic valve thickening. (D) Severe aortic stenosis (0.76 cm2 area) measured by planimetry during systole (30% of the RR interval).

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  Figure 4. Cardiac Magnetic Resonance (A) Axial scouter, depicting pulmonary congestion and pleural effusion as indirect signs of heart failure. (B and D) Aortic valve short-axis view, showing isointense central mass in T1-weighted sequence and hyperintense in T2-weighted sequence, respectively (red arrows). (C) Perfusion study sequence with no evidence of cardiac valve mass perfusion.

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  Figure 5. Cardiac Magnetic Resonance (A and B) Three-chamber view–like inversion recovery stack, depicting hypointense mass over aortic valve (red arrows). (C and D) Apical short-axis view and 2-chamber view–like inversion recovery sequences, showing focal and transmural inferior apical myocardial late gadolinium enhancement, respectively (yellow arrows).

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  Figure 6. Aortic Valve Histology (A) Clumps of fibrin on and within the aortic valve leaflet tissue (hematoxylin-eosin stain, ×40). (B) Chronic subendocardial inflammatory infiltrate with plasma cells and lymphocytes (hematoxylin-eosin stain, ×100). (C) The tissue material predominantly composed of abundant fibrin (hematoxylin-eosin stain, ×40).