Work

Giant Aortic Lambl's Excrescence

Year: 2026

Type: article

Abstract: BACKGROUND: Lambl's excrescences (LEs) are thin, filamentous valvular strands that are usually small and asymptomatic, however when they are large and mobile, they can cause embolic or obstructive events. CASE SUMMARY: A 59-year-old man presented with recurrent angina-like chest pain. Coronary angiography showed an intermediate lesion in the left anterior descending artery without hemodynamic relevance. Echocardiography revealed a highly mobile, 20- to 30-mm filamentous structure attached to the left coronary cusp, intermittently prolapsing toward the left coronary ostium and causing moderate aortic regurgitation. Surgical excision and aortic valve replacement were performed through a ministernotomy. Symptoms resolved, and histopathology confirmed a giant LE. DISCUSSION: Giant or hypermobile LEs can dynamically obstruct coronary ostia, mimicking atherosclerotic angina, even without significant coronary vascular disease. Surgical treatment is recommended when lesions are large, symptomatic, or associated with an increased risk of embolism. TAKE-HOME MESSAGE: Large LEs may cause coronary obstruction; multimodality imaging is essential, timely surgical removal provides relief and prevents ischemic or embolic complications.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.106947

Authors: Carl-Mattheis Wahl, Ralf Günzinger, Maria-Beatrix Weber, Christian Nöbauer, Markus Krane, Stephanie Voss

Institutions: Deutsches Herzzentrum München, Technical University of Munich, German Centre for Cardiovascular Research

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850