Mitral Valve Replacement for Libman-Sacks Endocarditis in Antiphospholipid Syndrome Secondary to Systemic Lupus Erythematosus Complicated with Thrombocytopenic Purpura
10.4326/jjcvs.38.67
- VernacularTitle:抗リン脂質抗体陽性 SLE に血小板減少性紫斑病を合併した Libman-Sacks 型心内膜炎の1手術例
- Author:
Masaharu Yoshikawa
;
Osamu Kawaguchi
;
Akira Takanohashi
;
Kei Yagami
;
Fumiaki Kuwabara
;
Yuichi Hirate
;
Yoshiya Miyata
- Publication Type:Journal Article
- Keywords:
SLE
- From:Japanese Journal of Cardiovascular Surgery
2009;38(1):67-70
- CountryJapan
- Language:Japanese
-
Abstract:
A 42-year-old woman with antiphospholipid syndrome (APLS) secondary to systemic lupus erythematosus (SLE) complicated with thrombocytopenic purpura was successfully treated by mitral valve replacement with a mechanical prosthesis and tricuspid valve annuloplasty for mitral valve stenosis and regurgitation due to Libman-Sacks endocarditis. Intraoperative hemorrhagic oozing due to thrombocytopenia was effectively managed with platelet transfusion. Negative microbial culture and pathological examination of the resected mitral valve demonstrated an atypical sterile verrucose lesion, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was successfully discharged 31 days after the operation without any hemorrhagic or thromboembolic events. However, 100 days after surgery, she suffered from fatal cerebral infarction caused by poor Coumadin compliance. Regarding the prosthetic valve selection, it is reasonable to select the mechanical valve because 1) anticoagulation therapy is necessary for APLS, 2) the risk of the dialysis induction due to the lupus-induced renal failure leading to a high calcium turnover, which results in accelerated bioprosthetic valve calcification. In case of SLE with APLS, in which anticoagulation and antiplatelet therapy is required to prevent the thromboembolic event and thrombocytopenic purpura, after valve replacement, strict management of anticoagulation plays an essential role to prevent thromboembolic complication.
