Limits...
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

Macroscopy and microscopy of the involved tricuspid valve and vegetation. a Yellow arrowhead: The large vegetation, Blue arrowhead: rupture mainchordae tendinae. b Blue arrowheads: Multiple verrucous nodular vegetation on the atrial surface of leaflet. c Resected tricuspid valve. Blue arrowheads: multiple small vegeatations, Yellow arrowhead: rupture main chordae tendinae. d microscopy of the vegetation adhered to the leaflet, Magnification 4×, Hematoxylin and Eosin stain. e enlarged square area in (e) showing inflammatory cell infiltration and fibrin-platelet thrombi, Magnification 20×, Hematoxylin and Eosin stain
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Macroscopy and microscopy of the involved tricuspid valve and vegetation. a Yellow arrowhead: The large vegetation, Blue arrowhead: rupture mainchordae tendinae. b Blue arrowheads: Multiple verrucous nodular vegetation on the atrial surface of leaflet. c Resected tricuspid valve. Blue arrowheads: multiple small vegeatations, Yellow arrowhead: rupture main chordae tendinae. d microscopy of the vegetation adhered to the leaflet, Magnification 4×, Hematoxylin and Eosin stain. e enlarged square area in (e) showing inflammatory cell infiltration and fibrin-platelet thrombi, Magnification 20×, Hematoxylin and Eosin stain

Mentions: Due to the uncontrolled and evolved right heart failure, the patient received emergent surgery intervention. Considering her uncontrolled SLE and time-limited steroids treatment, the patient was in status of uncontrolled systemic inflammatory response, which leaded to acute pericarditis and pericardial adhesion, also with edema of heart tissue. We had spent more time to expose the heart and establish cardiopulmonary bypass. Intraoperative macroscopy showed a 5 mm*5 mm*5 mm vegetation attached to the apex of tricuspid anterior leaflet, multiple verrucose nodular vegetations tightly adhered to the leaflet and subvavular apparatus. The main chordae tendinae of the leaflet was also ruptured due to vegetation erosion (Fig. 2a–c). Due to the massive vegetations and inflammation-induced tissue weakness, a final decision of valve replacement was made and a 31 mm Medtronic Hancock bioprosthesis was implanted. The surgery and post-operation procedure were both uneventful. The girl presented no symptom of heart failure and discharged 1 weeks later but with continuous follow-ups for heart surgery and further prednisone treatment of SLE. Histopathological examination of the excised vegetation showed inflammation with neutrophil infiltration combined with fibrin-platelet thrombi formation (Fig. 2d–e). The patient was alive 3 months after surgery and echocardiogram follow-up showed normal tricuspid bioprosthesis function without regurgitation.Fig. 2


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)

Macroscopy and microscopy of the involved tricuspid valve and vegetation. a Yellow arrowhead: The large vegetation, Blue arrowhead: rupture mainchordae tendinae. b Blue arrowheads: Multiple verrucous nodular vegetation on the atrial surface of leaflet. c Resected tricuspid valve. Blue arrowheads: multiple small vegeatations, Yellow arrowhead: rupture main chordae tendinae. d microscopy of the vegetation adhered to the leaflet, Magnification 4×, Hematoxylin and Eosin stain. e enlarged square area in (e) showing inflammatory cell infiltration and fibrin-platelet thrombi, Magnification 20×, Hematoxylin and Eosin stain
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Macroscopy and microscopy of the involved tricuspid valve and vegetation. a Yellow arrowhead: The large vegetation, Blue arrowhead: rupture mainchordae tendinae. b Blue arrowheads: Multiple verrucous nodular vegetation on the atrial surface of leaflet. c Resected tricuspid valve. Blue arrowheads: multiple small vegeatations, Yellow arrowhead: rupture main chordae tendinae. d microscopy of the vegetation adhered to the leaflet, Magnification 4×, Hematoxylin and Eosin stain. e enlarged square area in (e) showing inflammatory cell infiltration and fibrin-platelet thrombi, Magnification 20×, Hematoxylin and Eosin stain
Mentions: Due to the uncontrolled and evolved right heart failure, the patient received emergent surgery intervention. Considering her uncontrolled SLE and time-limited steroids treatment, the patient was in status of uncontrolled systemic inflammatory response, which leaded to acute pericarditis and pericardial adhesion, also with edema of heart tissue. We had spent more time to expose the heart and establish cardiopulmonary bypass. Intraoperative macroscopy showed a 5 mm*5 mm*5 mm vegetation attached to the apex of tricuspid anterior leaflet, multiple verrucose nodular vegetations tightly adhered to the leaflet and subvavular apparatus. The main chordae tendinae of the leaflet was also ruptured due to vegetation erosion (Fig. 2a–c). Due to the massive vegetations and inflammation-induced tissue weakness, a final decision of valve replacement was made and a 31 mm Medtronic Hancock bioprosthesis was implanted. The surgery and post-operation procedure were both uneventful. The girl presented no symptom of heart failure and discharged 1 weeks later but with continuous follow-ups for heart surgery and further prednisone treatment of SLE. Histopathological examination of the excised vegetation showed inflammation with neutrophil infiltration combined with fibrin-platelet thrombi formation (Fig. 2d–e). The patient was alive 3 months after surgery and echocardiogram follow-up showed normal tricuspid bioprosthesis function without regurgitation.Fig. 2

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