Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

A 35-year-old woman with a history of systemic lupus erythematosus presented with symptoms of congestive heart failure. She was treated with diuretics with resolution of her dyspnoea. Laboratory testing revealed a white-cell count of 7300/mm3, creatinine was 2.2 mg/dL, and C-reactive protein level was 10.2 mg/L (normal < 5). Repeated blood cultures were negative. Transthoracic echo demonstrated thickened mitral valve leaflets and severe mitral regurgitation. On 3D transoesophageal echocardiography, vegetations were observed on the atrial (Panel A, arrow) as well as the ventricular aspect (Panel B, arrows) of the posterior mitral leaflet, consistent with Libman–Sacks endocarditis (LSE).

In their 1924 seminal paper Libman and Sacks described four patients with a new form of endocarditis identified at autopsy. It was characterized as ‘…free from demonstrable micro-organisms’, emphasizing that ‘…the lesions on the posterior cusp of the mitral valve were situated chiefly on the ventricular aspect of the valve’. 2D echocardiography primarily images the atrial aspect of the mitral valve leaflets and is limited in its ability to image the valve from the ventricular side (see Supplementary data online, Videos S1andS2). Hence LSE vegetations have been described on echocardiography as being on the atrial surface of the mitral valve leaflets. 3D echocardiography allows the visualization of the undersurface of the mitral valve. This enables the detection of vegetations on the ventricular aspect of the mitral valve (Panel B and Supplementary data online, Video 3) as originally described in Libman and Sacks’ autopsy case series (Panel C, arrowheads). This patient was discharged home for future surgical re-evaluation.

Topic:
Issue Section:
IMAGE FOCUS
You do not currently have access to this article.
Download all slides