Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature

Abstract

Libman-Sacks endocarditis of the mitral valve was first described by Libman and Sacks in 1924. Currently, the sterile verrucous vegetative lesions seen in Libman-Sacks endocarditis are regarded as a cardiac manifestation of both systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). Although typically mild and asymptomatic, complications of Libman-Sacks endocarditis may include superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery. In this study we report two cases of mitral valve repair and two cases of mitral valve replacement for mitral regurgitation (MR) caused by Libman-Sacks endocarditis. In addition, we provide a systematic review of the English literature on mitral valve surgery for MR caused by Libman-Sacks endocarditis. This report shows that mitral valve repair is feasible and effective in young patients with relatively stable SLE and/or APS and only localized mitral valve abnormalities caused by Libman-Sacks endocarditis. Both clinical and echocardiographic follow-up after repair show excellent mid- and long-term results.

A Case of Libman-Sacks Endocarditis that Developed after Infective Endocarditis

“…It looked like non-bacterial vegetation, the same as reported in previous case studies [5,6]. Therefore, she was suspected to have a thrombophilic condition, and was found to have APS.…”

Antiphospholipid syndrome associated with non-infective mitral valve endocarditis: a case report

“…Sometimes acute myocardial infarction is the fi rst manifestation of antiphospholipid syndrome (8). Although endocarditis within the antiphospholipid syndrome is usually mild and asymptomatic, complications can include an superimposed bacterial infection, thromboembolic complications and severe regurgitation and/or stenosis which requires cardiac surgery (9). Venous thrombosis, usually on lower extremities occur in 55% of cases within this syndrome.…”

Mitral Valve Perforation in Libman–Sacks Endocarditis: A Heart-Wrenching Case of Lupus

“…7 Although it characteristically has negligible hemodynamic significance, when present, it is strongly associated with cerebrovascular and peripheral arterial embolism, cognitive dysfunction, acute and chronic valvular dysfunction, superimposed infective endocarditis, and the need for high-risk valvular surgery. 2,8,9 There is scant literature regarding the diagnostic and treatment dilemma providers face when valve perforation occurs in the setting of LS endocarditis. We conducted a systematic review of the literature on valve perforation caused by LS endocarditis, in which we performed a PubMed query with the keywords BLibman Sacks^and Bperforation^as well as BLibman Sacks^and Brepair.^Abstracts were reviewed and relevant papers were selected.…”

“…Bouma and colleagues described a 49-year-old man with a history of SLE who presented with dyspnea, signs of cardiac decompensation, elevated Creactive protein (CRP) (38 mg/l) and a normal white blood cell count (WBC, 4.6 × 10 9 /l). 8 He had severe mitral regurgitation and a small perforation in the P2 section of the posterior leaflet, with vegetation near the perforation. The mitral valve was repaired by resection of the P2 section and implantation of an annuloplasty ring.…”