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Mitral stenosis in systemic lupus erythematosus. Successful management by mitral valve replacement
P A Reilly1, P J Maddison, R D Thomas
1Royal National Hospital for Rheumatic Diseases, Bath, UK.
Insights
Systemic lupus erythematosus (SLE) can cause severe mitral stenosis, a heart valve condition, even without a history of rheumatic fever. Surgical valve replacement with a pericardial xenograft proved effective for this steroid-modified Libman-Sacks endocarditis case.
Area of Science:
- Cardiology
- Rheumatology
- Pathology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
- Cardiac involvement in SLE can range from pericarditis to valvular disease.
- Libman-Sacks endocarditis is a rare, non-bacterial thrombotic endocarditis associated with autoimmune diseases.
Observation:
- A female patient with an 18-year history of SLE presented with symptoms suggestive of mitral stenosis.
- She had no prior history of rheumatic fever, a common cause of mitral stenosis.
- Cardiac investigations confirmed severe mitral stenosis.
Findings:
- The patient underwent successful mitral valve replacement using a pericardial xenograft.
- Histopathological examination of the resected valve was consistent with steroid-modified Libman-Sacks endocarditis.
- The patient remained clinically well 24 months after the surgery.
Implications:
- This case highlights the potential for SLE to cause severe valvular heart disease, specifically mitral stenosis.
- Steroid-modified Libman-Sacks endocarditis should be considered in SLE patients presenting with valvular abnormalities.
- Surgical intervention, such as valve xenotransplantation, can be a viable treatment option for SLE-related valvular dysfunction.
Abstract:
A female Caucasian with a history of 18 years of systemic lupus erythematosus (SLE) developed symptoms and signs of mitral stenosis, but had no history of rheumatic fever. Investigations confirmed severe stenosis, and the diseased valve was replaced by a pericardial xenograft. Histological examination was compatible with steroid-modified Libman-Sacks endocarditis. She remains well 24 months postoperatively.