Influence of Systemic Lupus Erythematosus on Procedure Selection and Outcomes of Patients Undergoing Isolated Mitral Valve Surgery

Vassileva, Christina M.; Swong, Michael N.; Boley, Theresa M.; Markwell, Stephen; Hazelrigg, Stephen R.

doi:10.1111/j.1540-8191.2011.01393.x

Cited by 9 publications

(8 citation statements)

References 17 publications

(39 reference statements)

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“…In current cardiac surgery, there is no doubt about the superiority of mitral valve repair versus replacement whenever possible for most cases of mitral regurgitation by different etiologies [5]. It is associated with better preservation of left ventricular function and fewer valve related complications [3]. …”

Section: Discussionmentioning

confidence: 99%

“…If SLE status has been fairly stable with medical management and intraoperative examination shows absence of severe structural damage (with only localized and limited abnormalities), if repair seems possible and practical, then mitral valve repair is the preferred surgical option [3, 5, 16, 17]. If there is extensive fibrous network relating to papillary muscles, it may prohibit durable repair.…”

Section: Discussionmentioning

confidence: 99%

“…In the subject of mitral valve replacement, prosthetic valve selection is highly individualized based on age, APS association, and other conditions such as situations which need a prolonged anticoagulation use, like atrial fibrillation [3, 5, 16]. …”

Section: Discussionmentioning

confidence: 99%

“…Most parts of the heart may be affected in the course of systemic lupus erythematosus (SLE): coronary arteries, valves, conduction system, pericardium, myocardium, and endocardium, with a variety of clinical manifestations, and it is the main cause of morbidity and mortality in these patients [1–3]. Valvular involvement is the frequent cardiac manifestation in SLE.…”

Section: Introductionmentioning

confidence: 99%

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Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus

Foroughi

Hekmat

Ghorbani

et al. 2014

The Scientific World Journal

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Valvular heart disease is the common cardiac manifestation of systemic lupus erythematosus (SLE) with a tendency for mitral valve regurgitation. In this study we report a case of mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis in the setting of SLE. In addition, we provide a systematic review of the literature on mitral valve surgery in the presence of Libman-Sacks endocarditis because its challenge on surgical options continues. Surgical decision depends on structural involvement of mitral valve and presence of active lupus nephritis and antiphospholipid antibody syndrome. Review of the literature has also shown that outcome is good in most SLE patients who have undergone valvular surgery, but association of antiphospholipid antibody syndrome with SLE has negative impact on the outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus

Foroughi

Hekmat

Ghorbani

et al. 2014

The Scientific World Journal

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“…In addition, some cases of early bioprosthetic valve failure attributed to an autoimmune process have been described in the specific subgroup of patients with an autoimmune disease. 6) However, a recent study of 9 such patients who underwent valve replacement has recommended the use of a bioprosthetic valve to reduce the risks of postoperative morbidity and mortality. 7) Because of a small number of operated cases and the lack of long-term results of valve replacement, criteria for selection of a prosthetic valve are not clearly established in patients with SS, and further studies are needed to investigate which prosthetic valve would be more optimal.…”

Section: Discussionmentioning

confidence: 99%

Aortic Stenosis in a Patient With Sjogren’s Syndrome

et al. 2016

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SummarySjogren's syndrome (SS) is an autoimmune disease characterized by dryness of the mouth and the eyes. Systemic involvement in SS is well known, however, obvious cardiac manifestations, particularly significant valve disorders, are extremely rare and only three cases of significant valve disease associated with SS that required surgical intervention have been previously described. We report a case of aortic stenosis (AS) associated with SS in an elderly patient. The diagnosis of primary SS had been made based on clinical features, positive ocular signs, and positive serologic findings. Echocardiography showed severe calcification, elevated mean pressure gradient (57 mmHg), and a small orifice area (0.45 cm 2 ) of the aortic valve. At surgery, severe calcification of the aortic cusps and the annulus was the mechanism of AS, and the aortic valve was replaced with a bioprosthetic valve. Valve pathology showed nodular calcification and hyaline degeneration, but lymphocyte infiltration was not evident. The etiologic relation of SS to the valve lesions is not clear pathologically in this case, however, chronic inflammation related to immunologic reactions in SS could have some effect on exacerbation for degeneration of the valve tissue. (Int Heart J 2016; 57: 251-253) Key words: Autoimmune disease, Bioprosthetic valve, Heart valve disease, Mechanical valve, Valve replacement S jogren's syndrome (SS) is an autoimmune disease characterized by keratoconjunctivitis sicca (dry eye) and xerostomia (dry mouth) that is the result of lymphocyte-mediated destruction of exocrine glands, and mostly affects middle-aged women. The systemic manifestations of SS such as articular, lung, kidney, vascular, and gastrointestinal involvement are well known, however, obvious cardiac manifestations are rare, although clinically silent involvements are fairly common on echocardiography.1) To our knowledge, only a few cases of clinically significant cardiac valve disease associated with SS that required surgical intervention have been described in the literature. 2-4)In this paper, we report a case of aortic stenosis (AS) associated with SS, and discuss prosthetic valve selection in valve surgery for patients associated with an autoimmune disorder.The current study was approved by our institutional Research Ethics Board at the Munakata Suikokai General Hospital, and written informed consent was obtained from the patient for publication of this case report and any accompanying images. Case ReportA 70-year-old woman was admitted to our hospital for nocturnal dyspnea and chest pain. She had never smoked and had no history of rheumatic fever or diabetes mellitus, but she was on medication for hypertension and dyslipidemia for more than 10 years. At the age of 66 the patient had been diagnosed with Castleman's disease (hyaline-vascular type) after lymph node biopsy, and primary SS based on clinical features (dry mouth and eyes), ocular signs (a Shirmer's test; ≤ 3 mm in 5 minutes, rose Bengal score ≥ 4), and serological findings ( Table).5...

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