Surgical management of Libman-Sacks mitral valve endocarditis

Libman-Sacks endocarditis is a non-bacterial form of thrombotic endocarditis that is associated with Systemic Lupus erythematous (SLE) syndrome.

A 32 years old male with SLE and Antiphospholipid syndrome, presented with shortness of breath, intermittent chest pain and pyrexia. He had an embolic cerebral infarct a year previously with recurrent seizures. Echocardiogram showed severe Mitral regurgitation with a fixed posterior leaflet and Mobile structures on the leaflet tips. He underwent mechanical Mitral valve replacement. Vegetation was found on valve leaflets. Blood and valve tissue Cultures were sterile. Valve histology showed scarring and active inflammatory changes but no bacterial or fungal colonies.

In such case a durable valve repair cannot be gauranteed and bioprosthetic valve replacement is prone to early structural degeneration requiring re intervention especially in young patients. Mechanical valve has capacity to withstand the destructive inflammatory milieu of SLE and chronic renal failure.

A mechanical valve replacement is a reasonable choice in a young patient with SLE in the setting of antiphospholipid syndrome to reduce valvular re-intervention rate.