[HSF] Lupus and MR

[prasannasimha]

The crux of the issue is that you said the leaflets look like Barlow's 
with no leaflet restriction. Libman Sack verrucous vegetations will be 
found in varying degrees on every SBE case and do not cause "valvular 
damage" per se unless they get secondarily infected. If the leaflets are 
thin on inspection intraop go for it.
I would also ask the blood bank to check the cross match of the patient 
and also look for auto and warm + cold agglutinins.
Prasanna
Ramaiah, Chandrashekar wrote:
> Hal, Ani, and Prasanna-
> There is not much in the literature on this subject, only case reports.
> Most of them justify replacing with a mechanical valve as Lupus can
> destroy the bioprosthesis and repaired valve (again 1 or 2 cases). I
> could only find one by Carpentier where he replaced with a homograft.
>
> This patient has proven SLE with renal involvement (Class III lupus
> nephritis), and heart involvement. Had thrombocytopenia in the past
> responded to Immunosuppression with Steroids and Imuran.
>
> Her valve "looks like Barlow's" but it has features of Libman Sach's
> endocarditis. This is probably the reason the cardiologist did not refer
> her for replacement (thinking that she will get a mechanical Valve) for
> nearly 3 years and did when she became a NYHA IV.
> What other problems do you expect in post op period and how to handle
> it?
>
> Chand
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of
> hgrmd at aol.com
> Sent: Sunday, February 25, 2007 7:59 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Lupus and MR
>
> Chand,
>   I'm not aware of any contraindication to repairing a Barlow's valve in
> an SLE patient.  Whenever I've had a cardiologist refer the patient with
> orders to replace, I tell him to just let me do my job.  I then repair
> the valve if it is feasible.  I find that kind of presumptive behavior
> by the cardiologist quite annoying.  As for the SLE, I have had 2
> patients with SLE develop fatal postop mediastinitis.  They account for
> 1/2 of the fatal mediastinitis occuring in my private practice over the
> last 17 years.  
> Hal 
>  
> -----Original Message-----
> From: crama01 at email.uky.edu
> To: OpenHeart-L at lists.hsforum.com
> Sent: Sun, 25 Feb 2007 8:54 AM
> Subject: [HSF] Lupus and MR
>
>
> 30 y/o has severe bileaflet prolapse and looks as if it is a severe case
> of 
> myxomatous degeneration. Patient and the referring cardiologist is
> requesting a 
> mechanical valve and I think it can be repaired easily. 
> Any concerns with the durability of repair in a patient with SLE.
> Chand
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