Libman-Sacks Endocarditis with Unusual Large Size Vegetation Involving the Mitral Valve
AbstractAntiphospholipid syndrome (APS) is an autoimmune hypercoagulable disorder characterized by thrombophilia, vascular thrombosis, and recurrent abortions associated with persistent antiphospholipid antibodies. APS may exist in its primary form, or more commonly is found to be associated with variety of rheumatic disorders, such as systemic lupus erythematosus. Cardiac involvement is not an uncommon complication in primary antiphospholipid patients. Libman-Sacks lesions are typically small, sessile, and wart-like, varying in size from 1-4 mm. Here we present an unusual case of a 37 year-old pregnant woman who suffered from heart failure associated with primary antiphospholipid syndrome and Libman-Sacks endocarditis, with large vegetations involving the mitral valve. The patient underwent mitral valve replacement with a mechanical prosthesis.
Bouma W, Klinkenberg TJ, Horst ICC, Wijdh-den Hamer IJ, Erasmus ME, et al. 2010. Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature. J Cardiothoracic Surg 5:1-13.
Cervera R. 2004. Coronary and valvular syndromes and antiphospholipid antibodies. Thromb Res 114:501-7.
Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, et al. 2002. Antiphospholipid syn-drome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients. Arthritis Rheum 46:1019-27.
Davies JO, Hunt BJ. 2007. Myocardial infarction in young patients without coronary atheroscle-rosis: assume primary antiphospholipid syndrome until proved otherwise. Int J Clin Pract 61:379-384.
Hoffer E, Itoua M, Radermecker M, Pierard L. 2000. Stenosis of a mechanical mitral prosthetic valve in a patient with systemic lupus erythematosus. Acta Cardiol 55:49-5.
Lee JL, Naguwa SM, Cheema GS, Gershwin ME. 2009. Revisiting Libman-Sacks endocarditis: a historical review and update. Clin Rev Allergy Immunol 36:126-30.
Long BR, Leya F. 2008. The role of antiphospholipid syndrome in cardiovascular disease. He-matol Oncol Clin North Am 22:79-94.
Moaref AR, Afifi S, Rezaian S, Rezaian GR. 2010. Isolated tricuspid valve Libman-Sacks endo-carditis and valvular stenosis: unusual manifestations of systemic lupus erythematosus. J Am Soc Echocardiogr 23:341.
Nesher G, Ilany J, Rosenmann D, Abraham AS. 1997. Valvular dysfunction in antiphospholipid syndrome: prevalence, clinical features, and treatment. Semin Arthritis Rheum 27:27-35.
Pritzker MR, Ernst JD, Caudill C, Wilson CS, Weaver WF, et al. 1980. Acquired aortic stenosis in systemic lupus erythematosus. Ann Intern Med 93:434-436.
Roldan CA. 2008. Valvular and coronary heart disease in systemic inflammatory diseases: Sys-temic Disorders in heart disease. Heart 94:1089-101.
Roldan CA, Qualls CR, Sopko KS, Sibbitt WL. 2008. Transthoracic versus transesophageal echocardiography for detection of Libman-Sacks endocarditis: a randomized controlled study. J Rheumatol 35:224-229.
Roldan CA, Sibbitt WL Jr, Qualls CR, Jung RE, Greene ER, et al. 2013. Libman-Sacks endo-carditis and embolic cerebrovascular disease. JACC Cardiovasc Imaging 6:973-83.
Tanawuttiwat T, Dia M, Hanif T, Mihailescu M. 2011. Double-Valve Libman-Sacks Endocardi-tis Causing Ventricular Fibrillation Cardiac Arrest. Tex Heart Inst J 38:295-7.
Zhixuan Bai, Jianglong Hou, Wenjun Ren, Yingqiang Guo. 2015. Diagnosis and surgical treat-ment for isolated tricuspid libman-sacks endocarditis: a rare case report and literatures review. Journal of Cardiothoracic Surgery 10:93.
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