Lambl's Excrescences and Cardiac Papillary Fibroelastoma, an Unusual Cause of Embolic Strokes: Extended Data From a Single Center Case Series.

Background Lambl's excrescences (LE) and cardiac papillary fibroelastomas (CPF) are valvular structures that have been associated with cryptogenic strokes, potentially acting as embolic sources or sites of thrombus formation. However, the management of LE and CPF - whether discovered incidentally or in the setting of cerebrovascular events (cardiovascular accident (CVA)/transient ischemic attack (TIA)) - remains poorly defined, with no randomized trials to guide treatment. Methods We conducted a retrospective case series at a single center from July 2018 to June 2024, identifying 10 patients with LE or CPF. Nine patients presented with CVA/TIA; one had an incidental CPF finding. All patients were followed for a minimum of six months. The cohort had a mean age of 69.4 years (range 58-79 years), and common comorbidities included hypertension (7/10), diabetes (5/10), hyperlipidemia (4/10), coronary artery disease (2/10), and chronic kidney disease (1/10). Results No alternative stroke etiology was identified in CVA/TIA cases after standard evaluation. Management strategies included direct oral anticoagulants (n=5), warfarin (n=1), dual antiplatelet therapy (n=3), and surgical valve replacement (n=1). No recurrent strokes related to LE or CPF were observed during follow-up. Two patients later experienced strokes due to progressive carotid artery stenosis. Conclusions In this small, descriptive case series, individualized management strategies for LE and CPF appeared safe over short- to mid-term follow-up. Given the absence of consensus guidelines and randomized data, further research is needed to define optimal treatment and clarify causal relationships.