Echocardiography
Lambl (Wein Med Wschr vi, 1856, 244) described small filiform processes on the aortic valve. Margerey (J Path Bact 1949; 61:203-208) studied 250 mitral valves and postulated that the mechanism of formation is intimal damage due to mechanical trauma at the leaflet coaptation.
The damaged area is covered by fibrin, which subsequently becomes uplifted, or partially detached from the valve surface. A layer of intimal cells covers the surface of the fibrin deposit. The enclosed fibrin becomes condensed and hyaline constituting the excrescence. Organized hyaline substance is later replaced by fibrous and elastic tissue.
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