Resection of Lambl's Excrescence on the Aortic Valve in a Patient with Rheumatic Mitral Valve Disease and a Left Atrial Thrombus

Lambl's excrescences (LEs) are filiform strands that form on heart valves and are associated with an increased risk of stroke due to embolization. Although resection of these strands is generally recommended in patients who present with a stroke and no other identifiable cause, the management of incidentally discovered LEs in patients without an adverse cardioembolic event is less clear. We report a case of a patient with severe mitral valve stenosis from rheumatic heart disease and a large left atrial thrombus who was incidentally found to have multiple LEs on her aortic valve. In addition to replacing her mitral valve and removing the left atrial thrombi, we resected the LEs from her aortic valve due to their potential to cause a stroke and the relatively low associated morbidity in resecting them while keeping the aortic valve leaflets and valve function intact.