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Updated: Aug 2, 2025

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Multivalvular involvement associated with Libman-Sacks endocarditis detected by multimodality imaging: A case report
Son Tran Thanh Bui1, Phuong Hoang Nguyen2, Trang Ngoc Nguyen3
1Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam.
Libman-Sacks endocarditis, a complication in 6-11% of systemic lupus erythematosus patients, can affect heart valves. This case highlights rare bilateral valve involvement and the importance of multimodality imaging for diagnosis and management.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Libman-Sacks endocarditis (LSE) affects 6-11% of systemic lupus erythematosus (SLE) patients, leading to valvular dysfunction, stroke risk, and mortality.
- Left-sided LSE vegetations are more common; bilateral involvement is exceptionally rare.
- Comprehensive clinical assessment and multimodality imaging are crucial for managing SLE patients with potential cardiac complications.
Observation:
- A 31-year-old female with uncontrolled SLE presented with gastrointestinal symptoms.
- Routine echocardiography revealed a vegetation on the mitral valve's posterior leaflet.
- Further imaging confirmed mitral valve vegetation and an additional vegetation on the pulmonary valve.
Findings:
- Multimodality imaging, including 2D/3D echocardiography, cardiac MRI, and CT, characterized the vegetations.
- Echocardiography is the primary tool for detecting LSE vegetations.
- Cardiac MRI and CT are valuable for assessing lesion size, effects, and right-sided or multivalvular endocarditis.
Implications:
- This case underscores the possibility of rare bilateral LSE in SLE patients.
- Advanced imaging modalities aid in comprehensive characterization and management of complex LSE cases.
- The presence of brain lesions prompted antithrombotic therapy, emphasizing the link between cardiac and neurological manifestations.
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