Introduction
Case Reports
Patient 1
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 |
Patient 2
Patient 3
Patient 4
Systematic Review
Reference | Year published | Gender/ Age (years) | SLE and/ or APS | Years of SLE and/or APS | Steroids | MR gradeb
| MVR/MVP | Surgical procedure | Follow-up |
---|---|---|---|---|---|---|---|---|---|
Myerowitz et al [48] | 1974 | F/22 | SLE | 3 | yes | 4+ | MVR | Reis-Hancock porcine bioprosthesis | alive 2 months post-op |
Murray et al [49] | 1975 | F/43 | SLE | 2 | yes | 4+ | MVR | Beall Surgitoul mechanical prosthesis | alive 6 months post-op |
Paget et al [50] | 1975 | F/18 | SLE | 4 | yes | 4+ | MVR | Porcine xenograft (bioprosthesis) | alive 4 months post-op |
Kinney et al [51] | 1980 | F/27 | SLE | 0.3 | no | 4+ | MVR | Hancock porcine bioprosthesis | NR |
Rawsthorne et al [52] | 1981 | M/51 | SLE | 21 | no | 4+ | MVRc
| Hancock porcine bioprosthesis | NR |
Brennan et al
[53] | 1983 | F/20 | SLE | 2 | yes | 4+ | MVR | Björk-Shiley mechanical prosthesis | CVA 17 months post-op |
Rozman et al
[54] | 1986 | M/43 | SLE | 2 | yes | NR | MVR | Starr-Edwards mechanical prosthesis | alive 4 years post-op |
Moynihan et al
[55] | 1988 | F/54 | SLE | 2 | yes | 4+ | MVRc
| Carpentier-Edwards porcine bioprosthesis | alive 26 months post-op |
Straaton et al
[56] | 1988 | F/22 | SLE | <1 | no | 4+ | MVRd
| Carpentier-Edwards heterograft (bioprosthesis) | NR |
F/67 | SLE | 10 | yes | 2+/3+ | MVRc
| St. Jude mechanical prosthesis | died intraoperatively | ||
Ferraris et al
[57] | 1990 | M/34 | SLE | 9 | yes | 4+ | MVR | Carpentier-Edwards bioprosthesis | alive 2.5 years post-op |
Alvarez et al
[58] | 1994 | F/42 | APS | 1 | no | 2+/3+ | MVR | Medtronic Hall mechanical prosthesis | NR |
Kalangos et al
[40] | 1995 | F/28 | SLE | 0.5 | yes | 4+ | MVP | Resection of the prolapsed posterior commissure and restoration with an autologous pericardial patch; sliding plasty of the anterior leaflet; transposition of secondary chordae to the commisure; Carpentier- Edwards annuloplasty ring | no MR recurrence 1 year post-op |
Chauvaud et al [41] | 1995 | F/17 | SLE | 5 | yes | 4+ | MVP | Posterior leaflet enlargement with pericardial patch and Carpentier-Edwards annuloplasty ring | MS 6 months post-op due to calcification |
redo MVR | Cryopreserved homograft | alive 1 year post-op | |||||||
Shahian et al
[59] | 1995 | F/29 | APS | 0 | yes | 4+ | MVR | St. Jude mechanical prosthesis | alive 2 years post-op |
Gordon et al
[46] | 1996 | M/37 | SLE, APS | >2 | yes | 1+/2+ | MVRc
| Carpentier-Edwards porcine bioprosthesis | recurrent A-V fistula |
redo MVR | Carpentier-Edwards porcine bioprosthesis | died 1 month post-op | |||||||
Morin et al [33] | 1996 | F/40 | SLE | 12 | yes | 4+ | MVR | St. Jude mechanical prosthesis | alive 2 weeks post-op |
East et al [60] | 2000 | F/51 | SLE, APS | NR | no | 4+ | MVRe
| not further specified | NR |
F/49 | SLE, APS | 7 | yes | 4+ | MVR | not further specified | NR | ||
Hakim et al [42] | 2001 | F/23 | SLE | 8 | yes | 4+ | MVR | St. Jude mechanical prosthesis | alive >1 year post-op |
F/54 | SLE | 7 | yes | 4+ | MVPf
| not further specified | MR 29 months post-op | ||
redo MVR | St. Jude mechanical prosthesis | alive >5 years post-op | |||||||
F/64 | SLE | 2 | yes | 4+ | MVPe
| Quadrangular resection of the posterior leaflet and Duran annuloplasty ring | alive >3 years post-op | ||
Kato et al [43] | 2001 | F/52 | APS | NR | no | 4+ | MVP | Kay's annuloplasty and Cosgrove annuloplasty ring | alive 3 months post-op |
Mottram et al
[23] | 2002 | M/50 | APS | 0 | no | 0/1+ | MVP | Removal of two mitral valve masses | alive 9 weeks post-op |
da Silva et al
[47] | 2003 | F/54 | SLE, APS | 13 | yes | 4+ | MVR | Bioprosthesis (not further specified) | bioprosth. thrombosis and death 9 months post-op |
Schneider et al [44] | 2003 | M/23 | SLE | NR | NR | 4+ | MVP | not further specified | NR |
Georghiou et al [61] | 2003 | F/44 | SLE | 1 | yes | 3+ | MVRc,d
| St. Jude mechanical prosthesis | alive 6 months post-op |
Bordin et al [62] | 2003 | F/57 | SLE, APS | 3 | NR | 4+ | MVR | Mechanical prosthesis (not further specified) | MI 2 days post-op |
Berkun et al
[63] | 2004 | F/48 | APS | NR | yes | 3+/4+ | MVR | Carbomedics mechanical prosthesis | MR 90 months post-op |
redo MVR | not further specified | died 6 months post-op | |||||||
F/73 | APS | NR | yes | 3+/4+ | MVR | Hancock porcine bioprosthesis | died 13 months post-op | ||
F/47 | APS | NR | yes | 3+/4+ | MVRc
| Carbomedics mechanical prosthesis | splenic embolus 3 and CVA 10 months post-op alive 42 months post-op | ||
F/38 | SLE, APS | NR | yes | 3+/4+ | MVR | Carbomedics mechanical prosthesis | alive 32 months post-op | ||
F/51 | SLE, APS | NR | yes | 3+/4+ | MVR | Carbomedics mechanical prosthesis | alive 33 months post-op | ||
Fernández et al [45] | 2005 | F/36 | SLE | 8 | NR | 4+ | MVP | not further specified | mild MR 1 year post-op |
Taguchi et al
[24] | 2006 | F/34 | SLE | 9 | yes | 0/1+ | MVP | Resection of A3 and attached chordae (en-bloc); restoration of the anterior leaflet; 4 PTFE neochordae | no MR recurrence 6 months post-op |
Einav et al [64] | 2007 | F/28 | SLE, APS | 4.5 | yes | 4+ | MVRc,d
| Mechanical prosthesis (not further specified) | NR |
Takayama et al [16] | 2008 | M/58 | SLE, APS | 0 | no | 3+/4+ | MVP | Valvuloplasty and annuloplasty (not further specified) | NR |
Bouma et al
| 2010 | M/49 | SLE | 1.5 | yes | 4+ | MVP | Quadrangular resection of the posterior stable trace MR leaflet (P2) and Carpentier-Edwards annuloplasty ring | stable trace MR 11 years post-op |
M/56 | SLE | 4 | yes | 4+ | MVR | St. Jude mechanical prosthesis | alive >1.5 years post-op | ||
F/28 | APS | 1 | no | 4+ | MVR | St. Jude mechanical prosthesis | alive >1.5 years post-op | ||
F/22 | APS | 0.5 | no | 2+ | MVP | Quadrangular resection of the posterior leaflet (P2) and Cosgrove-Edwards annuloplasty ring | no MR recurrence 1.5 years post-op |