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Double-valve replacement for mitral and aortic regurgitation in a Patient with Libman-Sacks endocarditis
Kenta Hachiya1, Kazuaki Wakami, Tomomitsu Tani
1Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan.
Insights
Systemic lupus erythematosus can cause Libman-Sacks endocarditis, leading to heart valve damage. This case highlights valve replacement for severe mitral regurgitation due to non-bacterial endocarditis.
Area of Science:
- Cardiology
- Rheumatology
- Pathology
Background:
- Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are autoimmune conditions.
- Central nervous system (CNS) lupus is a serious manifestation of SLE.
- Libman-Sacks (LS) endocarditis is a non-infectious valvular complication of autoimmune diseases.
Observation:
- A 53-year-old woman with SLE and APS presented with CNS lupus and valve vegetation.
- Treatment for CNS lupus led to worsening mitral regurgitation and heart failure.
- Microscopic examination confirmed LS endocarditis without bacterial infection.
Findings:
- Libman-Sacks endocarditis manifested as clear vegetation on mitral and aortic valves.
- Surgical valve replacement was necessary due to severe mitral regurgitation and heart failure.
- The case demonstrates LS endocarditis affecting multiple heart valves.
Implications:
- Highlights the cardiac manifestations of SLE and APS.
- Emphasizes the importance of recognizing LS endocarditis in autoimmune patients.
- Underscores the need for timely intervention in cases of autoimmune-related valvular disease.
Abstract:
A 53-year-old woman with systemic lupus erythematosus and antiphospholipid syndrome presented with central nervous system (CNS) lupus and vegetation of the mitral and aortic valves. Her CNS lupus was relieved with methylprednisolone pulse therapy; however, her mitral regurgitation worsened, and she developed acute decompensated heart failure. The mitral and aortic valves were replaced with mechanical heart valves. Microscopic examination of the excised valves showed no bacterial invasion, and Libman-Sacks (LS) endocarditis of both valves was confirmed. This was a case of LS endocarditis with clear vegetation that spread over the mitral and aortic valves.
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