Double-valve Libman-Sacks endocarditis: An entity that demands special consideration

Background and aim of the study: Valvular heart disease, with a propensity for the left valves, is the most important cardiac manifestation of systemic lupus erythematosus (SLE). Libman-Sacks endocarditis complicating SLE has rarely been reported to cause hemodynamically significant valvular lesions necessitating valve replacement. Methods: This report describes a young woman with moderate aortic regurgitation and moderate to severe mitral regurgitation due to Libman-Sacks endocarditis. Results: Treatment consisted of aortic and mitral valve replacement with mechanical prostheses due to intractable heart failure. The patient's recovery was uneventful. Conclusion: A literature survey disclosed only nine reports of double-valve replacement in patients with SLE. These findings, together with the present experience, suggest that valvular disease in SLE changes frequently with time, appears to be temporally unrelated to the other clinical features of SLE, and is associated with substantial morbidity and mortality. Corticosteroid treatment may slow the progression of valvular regurgitation. If surgery is necessary, replacement with a mechanical valve may be better than with a bioprosthesis.