Aortic valve replacement for Libman-Sacks endocarditis

Keenan, Jack B.; Janardhanan, Rajesh; Larsen, Brandon T.; Khalpey, Zain

doi:10.1136/bcr-2016-215914

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…Apart from the clinical criteria for APS, there are multiple noncriteria manifestations of this disease 2 . Of these, nonbacterial thrombotic endocarditis (NBTE) is one that may lead to stroke or systemic embolism 3‐5 . The prevalence of NBTE in APS has varied in the literature with 23% of patients with systemic lupus erythematosus associated APS having NBTE in one meta‐analysis, and the prevalence of primary APS‐associated NBTE being estimated at between 61% and 82% in other studies 6‐9 .…”

Section: Introductionmentioning

confidence: 99%

“…2 Of these, nonbacterial thrombotic endocarditis (NBTE) is one that may lead to stroke or systemic embolism. [3][4][5] The prevalence of NBTE in APS has varied in the literature with 23% of patients with systemic lupus erythematosus associated APS having NBTE in one meta-analysis, and the prevalence of primary APS-associated NBTE being estimated at between 61% and 82% in other studies. [6][7][8][9] A large cohort of more than 1000 patients with both primary and secondary APS has estimated an overall prevalence of valvular disease of 11.7%.…”

Section: Introductionmentioning

confidence: 99%

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Antiphospholipid syndrome and the relationship between laboratory assay positivity and prevalence of non‐bacterial thrombotic endocarditis: A retrospective cohort study

Lenz

Mankad

Klarich

et al. 2020

Journal of Thrombosis and Haemostasis

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Background Nonbacterial thrombotic endocarditis (NBTE) is a potential complication of antiphospholipid syndrome (APS) manifesting as noninfectious lesions on one or more cardiac valves. There are limited tools to inform clinicians regarding which APS patients would benefit most from echocardiographic screening for this complication. Objectives We tested the hypothesis that the risk of both prevalent and incident NBTE is directly related to the number of positive laboratory assays for APS. Patients/methods In this single‐center, retrospective, cohort study design, consecutive patients with confirmed APS seen at Mayo Clinic Rochester, MN (1/1/1993‐6/26/2016), were identified by searching a centralized electronic database. Demographic data, clinical presentation, echocardiographic features, laboratory findings, and survival data were scrutinized. Results During the study period, 611 patients met the diagnostic criteria for APS and 386 (63%) underwent echocardiography. Of these, 58 (15%) were found to have NBTE. NBTE was more common in those with double (19.4%) and triple‐positive laboratory criteria (27.0%) compared with single‐positive disease (5.7%, P < .001). Survival free of NBTE diagnosis was significantly shorter in those patients with >1 positive laboratory assay (P < .01). Cox proportional hazard analysis suggests that patients with APS are more likely to be diagnosed with NBTE if they have >1 positive laboratory assay (relative risk 20.1; 95% confidence interval 1.3‐316.6; P < .03). Conclusion Antiphospholipid syndrome carries a high prevalence of NBTE (15%). This prevalence is particularly high for patients with either double‐ or triple‐positive laboratory criteria.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antiphospholipid syndrome and the relationship between laboratory assay positivity and prevalence of non‐bacterial thrombotic endocarditis: A retrospective cohort study

Lenz

Mankad

Klarich

et al. 2020

Journal of Thrombosis and Haemostasis

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“…Postoperatively there was no evidence of stroke or peripheral embolism. The literature has limited case reports about native aortic valve thrombosis with few cases suggesting poor outcomes 3 , 4 , 5 and thrombus persistence with anticoagulation, 6 , 7 therefore we followed a multidisciplinary approach, and the consensus was to proceed with surgical exploration and removal of thrombus. The thrombus was aspirated successfully; the patient did well and was discharged on coumadin without complications.…”

Section: Discussionmentioning

confidence: 99%

Aortic Sinus of Valsalva Thrombosis Presenting as Limb Ischemia: A Case Report

Shah

Kobrossi

Leatherman

et al. 2021

CASE

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“…This result is equivalent to that reported in a meta-analysis ( 29), finding that 3% of APS patients underwent valve replacement. Importantly, valvular replacement by mechanical prosthesis or bioprosthesis has been widely described APS with or without SLE ( [30][31][32][33][34][35] ) but never in aPL-SS. One patient underwent ascending aortic aneurysm surgery, even if the association between SS and aortic aneurysm occurrence is unclear.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic features in antiphospholipid-negative Sneddon’s syndrome and potential association with severity of neurological symptoms or recurrence of strokes: a longitudinal cohort study

Assan

Zuttere

Bottin

et al. 2020

European Heart Journal - Cardiovascular Imaging

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Aims Sneddon’s syndrome (SS) may be classified as antiphospholipid positive (aPL+) or negative (aPL− SS). An association between Libman–Sacks (LS) endocarditis and strokes has been described in aPL+ patients. To describe cardiac involvement in aPL− SS and assess the potential association between LS endocarditis and severity or recurrence of neurological symptoms. Methods and results This longitudinal cohort study included aPL− SS patients followed in our departments between 1991 and June 2018. All patients underwent transthoracic 2D and Doppler echocardiography at diagnosis. Follow-up echocardiography was performed annually and the potential relationship between LS endocarditis development and neurovascular relapse as well as long-term cardiac worsening was prospectively assessed. We included 61 patients [52 women; median age 45 (range 24–60)]. For valvular involvement, 36 (59%) patients showed leaflet thickening; 18 (29.5%) had LS endocarditis at baseline. During a median follow-up of 72 months, LS endocarditis developed in eight (17.4%) patients, and 13 (28.3%) showed significant worsening of their cardiac status, including two who needed valvular replacement. After adjusting for baseline antithrombotic treatment regimen, neither the presence of LS endocarditis at baseline nor development during follow-up was associated with neurological relapse [hazard ratio (HR): 1.06, 95% confidence interval (CI): 0.33–4.74, P = 0.92] and [HR: 0.38, 95% CI: 0.02–1.89, P = 0.31], respectively. Conclusion A long-term follow-up is needed to detect cardiac complications in aPL− SS. No change in neurological relapse was observed in patients presenting LS endocarditis occurrence during follow-up without any modification in antithrombotic treatment. Further research is necessary to assess the usefulness of treatment escalation in these patients.

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Aortic valve replacement for Libman-Sacks endocarditis

Cited by 8 publications

References 5 publications

Antiphospholipid syndrome and the relationship between laboratory assay positivity and prevalence of non‐bacterial thrombotic endocarditis: A retrospective cohort study

Antiphospholipid syndrome and the relationship between laboratory assay positivity and prevalence of non‐bacterial thrombotic endocarditis: A retrospective cohort study

Aortic Sinus of Valsalva Thrombosis Presenting as Limb Ischemia: A Case Report

Echocardiographic features in antiphospholipid-negative Sneddon’s syndrome and potential association with severity of neurological symptoms or recurrence of strokes: a longitudinal cohort study

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