title: Clinical significance and prevalence of valvular strands during routine echo examinations.
abstract: OBJECTIVE
  Lambl's excrescences (valvular strands) have been associated with an increased embolic risk. In previous studies, valvular strands have mostly been detected by transoesophageal echo (TEE). The current high-resolution echo systems allow better detection of valvular strands often even by transthoracic echocardiography (TTE). We attempted to determine the incidence of valvular strands during routine echo exams, TTE and/or TEE, and their relation to the cardiovascular risk factor, co-morbidities, and outcome.
  
  
  RESULTS
  Over 21 000 echo exams were performed at our hospital during 2008-12 and were searched for reporting of valvular strands. One hundred and fifty such studies were identified and the presence of valvular strands was confirmed. These patients were then evaluated for clinical characteristics, co-morbidities, and outcome, and compared with 150 age- and gender-matched patients without valvular strands. Incidence of valvular strands was maximal at age 61-70 (0.94%), and they were found more commonly in men than in women, 92 vs. 58, P < 0.00001. Valvular strands occurred more often on the aortic than on the mitral valve, 125 vs. 36, respectively, P < 0.00001, were more often associated with thickened or calcified aortic or mitral valve, and occupied the ventricular side of the aortic valve and the atrial side of the mitral valve, P < 0.00001. Embolic events occurred in 40 of the 150 patients with strands (27%). Valvular strands were not associated with increased mortality.
  
  
  CONCLUSIONS
  Valvular strands (Lambl's excrescences) appear not to affect life expectancy, but are often associated with embolic/cerebrovascular events, are more common in older patients, in men than in women, and are more commonly located on the aortic than on the mitral valve.
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Israel marina.leitman@gmail.com.
authors.forename: Marina
authors.initials: M
authors.lastname: Leitman
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tyomkin
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Peleg
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Israel.
authors.forename: Ruthie
authors.initials: R
authors.lastname: Shmueli
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Israel.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Krakover
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
mesh_terms: D000367:Age Factors; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors
keywords: Valvular strands