Libman–Sacks endocarditis

The Libman -Sacks endocarditis is a disease of the heart. It is a special form of abacterial endocarditis, which can be found in the syndrome of systemic lupus erythematosus (SLE). Your name goes back to the U.S. Internal Emmanuel Libman (1872-1946) and Benjamin Sacks, who first described this form of endocarditis 1924 four patients of Mount Sinai Hospital in New York as atypical verrucous endocarditis (atypical verrucous endocarditis).

Typical are large vegetations on the heart valves, which are usually fibrotic, or from proliferation of endothelial cells, myocytes and mononuclear inflammatory cells. Most vegetations are small and hemodynamically insignificant. The chordae tendineae may also have a strong thickening. There is a strong tendency to local inflammatory infiltrates. Not infrequently in addition occurs pleurisy or pericarditis. In 10% of patients, however, a valve insufficiency developed to heart failure.

Usually, the left heart valves are affected, most commonly the mitral valve followed by the aortic valve. By means of transthoracic ultrasound found signs of Libman -Sacks endocarditis in 7-11 % of patients with SLE, using transesophageal ultrasound to show changes in up to 43 % of SLE patients. In prematurely deceased SLE patients autopsies was the rate of endokarditischen changes 13-65 %.

Risk factors for endocarditis in SLE patients have a high disease activity, the presence of lupus nephritis and the presence of anti-phospholipid antibodies ( three fold higher risk ).

The optimal therapy of Libman -Sacks endocarditis is unknown. A decreased prevalence in SLE patients and the increased observation of healed lesions after advent of cortisone therapy in the 1970s suggested that this is efficient. Cohort studies, however, can not demonstrate a relationship between an immunosuppressive or cytotoxic medication and a change in the incidence or From the endocarditis. Individual reports also described a deterioration under cortisone therapy. Surgery is associated with a high risk of complications.

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