Question Title: Fibrin strands from aortic valve

A few months ago I experienced a small blind spot in my eye. I saw an ophthalmologist who diagnosed a cotton wool infarct which probably came from my heart. I was on birth control pills which I have since discontinued. I saw a cardiologist and had an electrocardiogram which was normal and a transesophageal echo which showed fibrin strands from my aortic valve. I had a blood culture which was negative. Two weeks ago I noticed another blind spot in the same eye (these spots are permanent) and the ophthalmologist confirmed another infarct. The cardiologist contemplated Coumadin but instead suggested 2 325mg aspirins a day. My questions are: Have you heard of fibrin strands causing emboli to the eye? (My cardiologist has not) Should I expect to be on anticoagulants for the rest of my life? (I am a 33 year old female),s Should I expect to never have children? Do I need antibiotic prophylaxis for routine dental cleaning? Thank you very much for answering - my primary care physician and cardiologist are difficult to ask.

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Dear Laura,
Firstly if you ever feel uncomfortable in any way with your physician and the
information he gives you or even the diagnosis he/she gives you, it is your
right to seek a second opinion elsewhere, if not request a referral to a specialist
who has not only heard of but has seen such cases. There are a lot of issues here
and I apologize for the delay in answering your question but there are many possible
causes to explain fibrinous strands on the aortic valve.
1)almost every anatomic abnormality of the heart structures warrants antibiotic prophylaxis
prior to dental and certain other procedures (any invasive procedure involving the genitourinary or
gastrointestinal tract, such as an EGD to evaluate the stomach for ulcers.)
2)the recommended # of blood cultures is at least three each 12hours apart to evaluate a patient
such as yourself for infective endocarditis(defined as infection of the heart lining and it's
valves.) Infective endocarditis is a very treatable disease that should be highly considered
in any individual with the history as you tell it, some patients are even treated when the blood
cultures are all negative simply because the clinical suspicion is high. IN your case the clinical
suspicion is high because someone your age should have nothing abnormal about their aortic valve (unless there
is a newly discovered structural defect- which would make the valve all the more likely to be infected)
and clinical suspicion is very high in you since you have had two embolic events-both very suspicious for
those 'strands' being endocarditis.
Infective endocarditis can be devastating if left untreated, the treatment usually requires care by a cardiology/infectious disease
combined team.
Once infective endocarditis is ruled out then and only then is a blood thinner like coumadin to be considered. Unfortunately, I can
not comment any further, please consider these suggestions highly and resubmit as needed if further events develop. Good Luck.
If you would like the opinion of one of the Cleveland Clinic's cardiologists that specializes in heart valve abnormalities simply call
1-800-CCF-CARE and ask for an appointment with a valve cardiologist at desk F15, for example Dr. R. Grimm. If Cleveland is simply too far
away, your best option then is to have a second opinion at the closest major university center,often these
are found in major cities(but this is not always so.)
Information provided in the heart forum is intended for general informational purposes only, actual diagnosis and treatment can only be made
by your physician(s).

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