title: Valvulitis involving a bioprosthetic valve in a patient with systemic lupus erythematosus.
abstract: A 37-year-old man with systemic lupus erythematosus, who underwent an aortic valve replacement with a Carpentier-Edwards porcine valve for severe aortic insufficiency, was admitted to the hospital with pulmonary edema. Transesophageal echocardiography revealed severe aortic insufficiency arising from partial dehiscence of the valve sewing ring, as well as centrally from the valve cusp. In addition, marked thickening of the mitral valve was observed with severe eccentric regurgitation. At surgery, valvulitis of the native mitral and bioprosthetic aortic valves was demonstrated, with a perforation of the porcine valve cusp. After replacement of both valves, the patient had a stormy postoperative course with recurrent communications between the left ventricle and atrium requiring multiple surgeries and eventually died. This case illustrates the severity of valvulopathy and ensuing complications that can affect patients with systemic lupus erythematosus and demonstrates that the valvulopathy can affect bioprosthetic valves, a finding that has significant implications as to the type of valve replacement in these patients.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Gordon
authors.forename: D
authors.initials: D
authors.lastname: Weilbaecher
authors.forename: S M
authors.initials: SM
authors.lastname: Davy
authors.forename: H J
authors.initials: HJ
authors.lastname: Safi
authors.forename: M A
authors.initials: MA
authors.lastname: Quiñones
authors.forename: C A
authors.initials: CA
authors.lastname: DeFelice
authors.forename: W A
authors.initials: WA
authors.lastname: Zoghbi
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D001705:Bioprosthesis; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000209:etiology*; D017809:Fatal Outcome; D006350:Heart Valve Prosthesis; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011475:Prosthesis Failure; D011654:Pulmonary Edema / Q000209:etiology; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000209:etiology