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

Table 1 Preoperative baseline characteristics of four patients with MR caused by LS endocarditis

Patient	1	2	3	4
Gender	Male	Male	Female	Female
Age (years)	49	56	28	22
SLE/APS	SLE	SLE	APS	APS
Years of SLE/APS	1.5	4	1	0.5
Steroids	yes	yes	no	no
Valve Lesion	MR	MR	MR	MR
NYHA class	IV	I	III	I
Echocardiography
-MR grade	4+	4+	4+	2+
-LV function	normal	normal	normal	normal
Cardiac Catheterization
-Coronary artery disease	no	no	no	NA
-PAP (mmHg) (N: 15-30/3-12 mmHg)	34/6	41/18	32/21	NA
-PCWP (mmHg) (N: 1-10 mmHg)	10	18	21	NA
-LVEDP (mmHg) (N: 3-12 mmHg)	10	18	19	NA
-Cardiac Output (L/min/m²) (N: 2.6-4.2 L/min/m²)	2.74	3.20	4.30	NA
Laboratory tests
-Repeated blood cultures	neg	neg	neg	neg
-CRP (mg/l) (N: 0-5 mg/l)	38	60	3	34
-White blood cell count (×10⁹/l) (N: 4.0-10.0 × 10⁹/l)	4.6	3.8	6.8	8.9
-Thrombocyte count (×10⁹/l) (N: 150-300 × 10⁹/l)	258	249	105	114
-Lupus anticoagulant (N: neg)	NA	NA	pos	pos
-Anti-cardiolipin Ab (IgG) (U/ml) (N: <10 U/ml)	<10	25	>100	53
-Anti-cardiolipin Ab (IgM) (U/ml) (N: <10 U/ml)	<10	<10	<10	<10
-Complement C3 (g/l) (N: 0.90-1.80 g/l)	0.39	0.77	1.19	1.57
-Complement C4 (g/l) (N: 0.10-0.40 g/l)	0.13	0.19	0.31	0.39
-Anti-Nuclear Antibody (ANA) titer (N: <20)	320	>640	40	40
-Anti-ds-DNA Ab (Farr-assay) (U/ml) (N: <10 U/ml)	11	154	<3	5
-Extractable Nuclear Antigens (ENA) (N: neg)	NA	neg	neg	neg

Ab, antibodies; APS, anti-phospholipid syndrome; CRP, C-reactive protein; ds-DNA, double stranded DNA; LS, Libman-Sacks; LV(EDP), left ventricular (end-diastolic pressure); MR, mitral regurgitation; N, normal values; NA, not available; NYHA, New-York heart association; PAP, pulmonary artery pressure; PCPW, pulmonary capillary wedge pressure; SLE, systemic lupus erythematosus

ISSN: 1749-8090