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Updated: Sep 14, 2025
09:31
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
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Flail Tricuspid and Mitral Valve in Neonatal Lupus
Michael N Gritti1, Surabhi Sivaratnam2, Osami Honjo3
1Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
JACC. Case Reports
|July 18, 2025
Summary
Neonatal lupus erythematosus (NLE) can cause rare, severe heart valve damage. Early valve replacement, potentially using a Melody valve, may be necessary for these critical cases.
Area of Science:
- Cardiology
- Neonatology
- Rheumatology
Background:
- Neonatal lupus erythematosus (NLE) commonly manifests as congenital heart block.
- Flail atrioventricular valve leaflets are an exceptionally rare presentation of NLE.
Observation:
- A neonate presented with severe atrioventricular valve insufficiency due to flail tricuspid and mitral valves.
- High anti-Ro60 antibody titers confirmed NLE.
- Initial management included steroids and immunoglobulins, followed by valve repairs.
Findings:
- This case represents the first report of NLE with bilateral atrioventricular valve chordal rupture.
- The neonate required extracorporeal membrane oxygenation due to persistent insufficiency.
- Mitral valve replacement was performed, first with a modified Melody valve, then a mechanical valve.
Implications:
- Highlights a severe, atypical presentation of NLE involving both tricuspid and mitral valves.
- Emphasizes the need for heightened diagnostic awareness and surveillance for valvular pathology in NLE.
- Suggests the Melody valve as a potential bridge to definitive mitral valve replacement in NLE.
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