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Chalvon, Nellie Bourse; Costedoat-Chalumeau, Nathalie; Pennaforte, Jean-Loup; Servettaz, Amelie; Boulagnon Rombi, Camille; Gavand, Pierre-Edouard; Lekieffre, Maud; Le Guern, Veronique; Morel, Nathalie; Cohen Aubart, Fleur; Haroche, Julien; Mathian, Alexis; Collet, Jean-Philippe; Piette, Jean-Charles; Amoura, Zahir; Orquevaux, Pauline

Severe Libman–Sacks endocarditis complicating antiphospholipid syndrome: a retrospective analysis of 23 operated cases

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  • Medientyp: E-Artikel
  • Titel: Severe Libman–Sacks endocarditis complicating antiphospholipid syndrome: a retrospective analysis of 23 operated cases
  • Beteiligte: Chalvon, Nellie Bourse; Costedoat-Chalumeau, Nathalie; Pennaforte, Jean-Loup; Servettaz, Amelie; Boulagnon Rombi, Camille; Gavand, Pierre-Edouard; Lekieffre, Maud; Le Guern, Veronique; Morel, Nathalie; Cohen Aubart, Fleur; Haroche, Julien; Mathian, Alexis; Collet, Jean-Philippe; Piette, Jean-Charles; Amoura, Zahir; Orquevaux, Pauline
  • Erschienen: Oxford University Press (OUP), 2023
  • Erschienen in: Rheumatology
  • Sprache: Englisch
  • DOI: 10.1093/rheumatology/keac315
  • ISSN: 1462-0324; 1462-0332
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>Data on severe heart valve disease (HVD), including Libman–Sacks endocarditis, associated with SLE and/or APS requiring valvular surgery are scarce. We thus conducted a retrospective study, aimed at describing and clarifying clinical, laboratory, echocardiographic, histopathological and evolutional features of SLE and/or APS patients with severe associated-HVD.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>An observational retrospective multicentric analysis of 23 adults with SLE and/or APS and HVD between 1996 and 2019 and available histopathological report evaluating long-term follow-up.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Twenty-three individuals (20 females, median age 37 [range 17–76] years) were included. All had APS (thrombotic in 22, with an arterial phenotype in 15 and with catastrophic APS [CAPS] in six), and 11 (47%) had SLE. Systemic underlying disease had been diagnosed prior to HVD in 12 (52%). In 10 patients (43%), HVD was complicated by cerebral stroke prior to surgery. Twenty patients (87%) had only one pathological valve, the mitral valve in 18 patients (78%). Valvular thickening (n = 19) and valvular regurgitation (n = 19) were the most frequently reported lesions. Fifteen (62%) patients underwent mechanical valve replacement, six (26%) conservative valve repair (five were later re-operated after a median time of 1 [0–4] year), and two (9%) underwent biological valve replacement. Nine patients (39%) presented early-onset post-operative complications, including three CAPS immediately after surgery and one death. After surgery, 18 patients (78%) had normal postoperative valvular function, but almost half of the patients (43%) had post-operative neurological sequelae (median follow-up of 6 [2–20] years).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Severe HVD leading to surgery was strongly associated with thrombotic APS, especially arterial phenotypes. Half of the reported patients presented cerebral stroke complicating the HVD. Valvular surgery carried a significant risk of CAPS.</jats:p> </jats:sec>
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