Nonbacterial thrombotic endocarditis

Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis in which small sterile vegetations are deposited on the valve leaflets. Formerly known as marantic endocarditis, which comes from the Greek marantikos, meaning "wasting away".[1] The term "marantic endocarditis" is still sometimes used to emphasize the association with a wasting state[2] such as cancer.[3]

"NBTE" redirects here. For educational board, see National Board for Technical Education.
Nonbacterial thrombotic endocarditis
SpecialtyCardiology 

Risk factors

Marantic vegetations are often associated with previous rheumatic fever.

Other risk factors include:

  • hypercoagulable states
  • malignant cancers, especially mucin-producing adenocarcinomas (most commonly associated with pancreatic adenocarcinomas)
  • systemic lupus erythematosus: Referred to as Libman-Sacks endocarditis
  • trauma (e.g., catheters)

Valve predilection

The disease affects the valves with following predilection: mitral valve > aortic valve > tricuspid valve > pulmonary valve [4]

Histopathology

Grossly, vegetations form along lines of valve closure and are generally symmetric with a smooth or verrucoid (warty) texture. Histologically, lesions are composed of fibrin[5] (eosinophilic) and platelets but, unlike bacterial etiologies, contain little evidence of PMNs, microorganisms or inflammation.

Diagnosis

Due to the non-invasive nature of NBTE, clinical examination may or may not reveal a new murmur.

An embolic stroke may be the first feature to suggest diagnosis of NBTE. An echocardiograph may be used to further assess for valvular lesions.

Treatment
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References
  1. Neurological Sequelae of Infectious Endocarditis at eMedicine
  2. "Noninfective Endocarditis: Endocarditis: Merck Manual Professional". Retrieved 2008-12-22.
  3. "Marantic endocarditis". Online Medical Dictionary. Retrieved 2008-12-22.
  4. "UpToDate".
  5. "nonbacterial thrombotic endocarditis" at Dorland's Medical Dictionary
Classification
External resources
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