Abstract
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.
Highlights
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 [1,2,3]
It has been shown that the prevalence of valvular disease in SLE can be more than 50% [4,5,6]
In right-sided valves, thickening and vegetation are more seen in tricuspid valve than pulmonary and there is a low prevalence of pulmonary hypertension in SLE patients [8, 9]
Summary
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 [1,2,3]. Involvement of all four valves could be seen in SLE patients. It has a preference on the left side of the heart, mainly on the mitral valve, followed by the aortic valve, but it can be seen on the papillary muscle and chordae tendinae, left atrial wall, left ventricular septum, and aortic wall. The valve involvement stimulates a broad spectrum of presentations It is typically mild and asymptomatic but can lead to fulminant presentation such as superimposed bacterial endocarditis, thromboembolic events, and congestive heart failure [1, 2, 5, 7]. Heart failure (due to mitral regurgitation) as the first manifestation of the disease was reported too [12]. We provide a systematic review of the literature for surgical consideration and highlight some important concerns that need to be addressed
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