Libman-Sacks Endocarditis

Libman-Sacks Endocarditis

Libman-Sacks Endocarditis (LSE) was described by Libman and Sacks in 1924 as sterile verrucous vegetations (non bacterial thrombotic endocarditis, verrucous endocarditis [1]) in cases of systemic lupus erythematosus (SLE). The lesions are due to deposition of immune complexes and mononuclear cells. The typical site is the ventricular surface of the posterior mitral leaflet. Lesions can also be seen on the aortic valve and rarely in other valves. Occasionally they can lead on to thromboembolic phenomena. Regurgitant lesions are more likely than stenotic lesions due to LSE. Rarely, these lesions can form the nidus for secondary infective endocarditis.

The vegetations of Libman-Sacks endocarditis can be detected by echocardiography. There may be associated thickening of the valve leaflets. The valvular lesions of Libman-Sacks endocarditis are seldom symptomatic. Rarely cardiac failure may develop in those with severe mitral regurgitation. But most often the features of SLE predominate. Valvular lesions are often associated with antiphospholipid antibodies. Autopsy series of SLE have reported vegetations in about half of the subjects, while echocardiographic series suggest valvular involvement in one fourth to three fourth of patients. Actual detection of vegetations on the valves by echocardiography is highly variable in various reports.

Reference

1. Abdisamad M. Ibrahim, Momin S. Siddique. Libman Sacks Endocarditis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.