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Diagnosis and surgical treatment for isolated tricuspid Libman-Sacks endocarditis: a rare case report and literatures review.

Bai Z, Hou J, Ren W, Guo Y - J Cardiothorac Surg (2015)

Bottom Line: The patient recovered following tricuspid valve replacement with a bioprosthesis.For patients with active SLE/APS course, uncontrolled systemic inflammation may made it difficult for surgical exposure and suture.The durability of bioprosthesis for this patient and the prosthesis selection for tricuspid LSE both need further follow-up and more clinical investigation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Xiang St., Chengdu, Sichuan, China. zhixuan.bai@foxmail.com.

ABSTRACT
Libman-Sacks endocarditis (LSE), characterized by verrucous vegetations formation, is a typical cardiac manifestation of autoimmune diseases such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). It primarily leads to lesions of cardiac valves and mostly involved valves are mitral and aortic, but isolated tricuspid valve involvement is exceptional. Here we reported a 20-years-old female with past SLE history suffered from acute right heart failure caused by multiple tricuspid vegetations and valve regurgitation. The patient recovered following tricuspid valve replacement with a bioprosthesis. Transesophageal echocardiography(TEE), especially real time 3-dimensional (RT3D) TEE provide a better imaging modality for assessing cardiac valvular involvement of LSE. For patients with active SLE/APS course, uncontrolled systemic inflammation may made it difficult for surgical exposure and suture. The durability of bioprosthesis for this patient and the prosthesis selection for tricuspid LSE both need further follow-up and more clinical investigation.

No MeSH data available.


Related in: MedlinePlus

Transesophgeal echocardiography images of the patient before surgery. a Tricuspid regurgitation, Yellow arrowhead: wide and reversed blood flow signals at TV site. b A large vegetation formation. Yellow arrowhead: A large vegetation adhere to anterior leaflet of TV. c Suspicious multiple vegetations on 3D echo image. Yellow arrowheads: multiple verrucous abnormal nodular projections on the leaflet surface. RA right atrium, RV right ventricle, LA left atrium, LV left ventricle, TV tricuspid valve
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Fig1: Transesophgeal echocardiography images of the patient before surgery. a Tricuspid regurgitation, Yellow arrowhead: wide and reversed blood flow signals at TV site. b A large vegetation formation. Yellow arrowhead: A large vegetation adhere to anterior leaflet of TV. c Suspicious multiple vegetations on 3D echo image. Yellow arrowheads: multiple verrucous abnormal nodular projections on the leaflet surface. RA right atrium, RV right ventricle, LA left atrium, LV left ventricle, TV tricuspid valve

Mentions: After admission the patient had transitional mild fever with the highest temperature of 37.9 °C. Heart auscultation showed systolic murmur at the 4th intercostal space by the left border of sternum. The transthoracic and transesophageal echocardiography (TTE and TEE) showed severe tricuspid regurgitation and a large single vegetation on the atrial surface of anterior leaflet, which was swinged by blood flow. Real time3-dimensional (RT3D)TEE further detected numerous verrucose nodular thickening on the leaflet’s atrial surface (Fig. 1). The computed tomography scan excluded existence of arteritis. Her laboratory test yielded the following: normal regular blood tests, elevated erythrocyte sedimentation rate and normal C-reactive protein level, positive antinuclear antibody (tite 1:1000), decreased complement C3 and C4 levels(C3, 0.50 g/l; C4, 0.11 g/l), and negative anti-double-stranded DNA antibody, negative anticardiolipin antibody and negative lupus anticoagulant. Hepatic and renal functions were all normal just after admission. Blood culture was taken for 3 times consecutively, but no existence of bacteria was shown. History of unhygienic intravenous injection was denied. Prednisone and hydroxychloroquine were given after admission for 2 weeks but the valve vegetations didn’t disappear according to TEE follow-ups, and the patient did show aggravated clinical symptoms of right heart failure such as loss of appetite, edema of lower extremities, polyserositis, hepatolienomegaly and continuous increasing hepatic function indexes.Fig. 1


Diagnosis and surgical treatment for isolated tricuspid Libman-Sacks endocarditis: a rare case report and literatures review.

Bai Z, Hou J, Ren W, Guo Y - J Cardiothorac Surg (2015)

Transesophgeal echocardiography images of the patient before surgery. a Tricuspid regurgitation, Yellow arrowhead: wide and reversed blood flow signals at TV site. b A large vegetation formation. Yellow arrowhead: A large vegetation adhere to anterior leaflet of TV. c Suspicious multiple vegetations on 3D echo image. Yellow arrowheads: multiple verrucous abnormal nodular projections on the leaflet surface. RA right atrium, RV right ventricle, LA left atrium, LV left ventricle, TV tricuspid valve
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4494164&req=5

Fig1: Transesophgeal echocardiography images of the patient before surgery. a Tricuspid regurgitation, Yellow arrowhead: wide and reversed blood flow signals at TV site. b A large vegetation formation. Yellow arrowhead: A large vegetation adhere to anterior leaflet of TV. c Suspicious multiple vegetations on 3D echo image. Yellow arrowheads: multiple verrucous abnormal nodular projections on the leaflet surface. RA right atrium, RV right ventricle, LA left atrium, LV left ventricle, TV tricuspid valve
Mentions: After admission the patient had transitional mild fever with the highest temperature of 37.9 °C. Heart auscultation showed systolic murmur at the 4th intercostal space by the left border of sternum. The transthoracic and transesophageal echocardiography (TTE and TEE) showed severe tricuspid regurgitation and a large single vegetation on the atrial surface of anterior leaflet, which was swinged by blood flow. Real time3-dimensional (RT3D)TEE further detected numerous verrucose nodular thickening on the leaflet’s atrial surface (Fig. 1). The computed tomography scan excluded existence of arteritis. Her laboratory test yielded the following: normal regular blood tests, elevated erythrocyte sedimentation rate and normal C-reactive protein level, positive antinuclear antibody (tite 1:1000), decreased complement C3 and C4 levels(C3, 0.50 g/l; C4, 0.11 g/l), and negative anti-double-stranded DNA antibody, negative anticardiolipin antibody and negative lupus anticoagulant. Hepatic and renal functions were all normal just after admission. Blood culture was taken for 3 times consecutively, but no existence of bacteria was shown. History of unhygienic intravenous injection was denied. Prednisone and hydroxychloroquine were given after admission for 2 weeks but the valve vegetations didn’t disappear according to TEE follow-ups, and the patient did show aggravated clinical symptoms of right heart failure such as loss of appetite, edema of lower extremities, polyserositis, hepatolienomegaly and continuous increasing hepatic function indexes.Fig. 1

Bottom Line: The patient recovered following tricuspid valve replacement with a bioprosthesis.For patients with active SLE/APS course, uncontrolled systemic inflammation may made it difficult for surgical exposure and suture.The durability of bioprosthesis for this patient and the prosthesis selection for tricuspid LSE both need further follow-up and more clinical investigation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Xiang St., Chengdu, Sichuan, China. zhixuan.bai@foxmail.com.

ABSTRACT
Libman-Sacks endocarditis (LSE), characterized by verrucous vegetations formation, is a typical cardiac manifestation of autoimmune diseases such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). It primarily leads to lesions of cardiac valves and mostly involved valves are mitral and aortic, but isolated tricuspid valve involvement is exceptional. Here we reported a 20-years-old female with past SLE history suffered from acute right heart failure caused by multiple tricuspid vegetations and valve regurgitation. The patient recovered following tricuspid valve replacement with a bioprosthesis. Transesophageal echocardiography(TEE), especially real time 3-dimensional (RT3D) TEE provide a better imaging modality for assessing cardiac valvular involvement of LSE. For patients with active SLE/APS course, uncontrolled systemic inflammation may made it difficult for surgical exposure and suture. The durability of bioprosthesis for this patient and the prosthesis selection for tricuspid LSE both need further follow-up and more clinical investigation.

No MeSH data available.


Related in: MedlinePlus