Dear Laura, thank you for your question. Marantic endocarditis refers to
nonbacterial thrombotic endocarditis which is valvular vegetations that are not
infected with microorganisms. Normally, small thrombi form on deformed valves
which are then colonized with bacteria that multiply and form a nidus of
infection that causes endocarditis. When small thrombi form on the valves and
are not infected, microemboli can be dislodged to cause events like what happened
with your eye. Marantic endocarditis is found with certain malignancies (pancreatic,
gastric, or lung), chronic kidney failure, connective tissue disorders like
lupus, or hypercoagulable states (an increased propensity of the blood to clot).
Before this diagnosis can be made, however, infective endocarditis needs to
be thoroughly excluded. The normal way to exclude an infection is to drawn two
sets of blood cultures three times over 1-2 days before antibiotics are started.
If these cultures are negative, then infective endocarditis is usually excluded.
However, culture-negative endocarditis can occur in patients who had received
antibotics prior to drawing blood cultures and in patients with unusual infections
that are hard to culture in the microbiology laboratory. There is a possibility
you had culture-negative endocarditis, but I will assume that you have a normal
aortic valve (other than the fibrin strands), so there would be no reason for
you to develop vegetations on a normal valve. I doubt you have a malignancy, but
there is a chance that you could have a hypercoagulable state that would predispose
you to forming clots. It's hard for me to recommend what should be done next,
but I think you should meet with your physicians again to determine if you
do have a hypercoagulable state, whether the TEE needs to be repeated to
reevaluate the fibrin strands, and whether you need a further work-up for
infectious causes. Additionally, your physicians may consider changing your aspirin
to a stronger blood thinner called coumadin. I hope this information helps in
your quest to determine the cause of the fibrin strand on your valve. If you
have further questions, please don't hesitate do write back.
Information provided in the heart fourm is for general purposes only. Specific
diagnoses and therapies can only be provided by your physician.