B-61 | Successful Mitral Valve Replacement for Libman-Sacks Endocarditis in a Young Woman With Developmental Delay and Recurrent Embolic Stroke: A Complex Case Successfully Managed

Libman-Sacks Endocarditis(LSE) is a rare form of non-infectious endocarditis with a prevalence of 0.9%-1.6%. It is associated with autoimmune diseases. When coupled with embolic complications, it presents diagnostic and management challenges. Case: A 38-year-old female with developmental delay, antiphospholipid antibody syndrome, and recent pulmonary embolism maintained on apixaban, presented with slurred speech. CT and MRI of the brain showed multiple bi-hemispheric infarcts consistent with acute embolic stroke. TEE showed a 1x2 cm mass on the posterolateral mitral valve with moderate mitral regurgitation. Blood cultures were negative. Patient underwent successful bioprosthetic mitral valve replacement (MVR). Pathology of the valve leaflet showed fibrous tissue and fibrin thrombus, confirming LSE. Decision Making: The patient and family preferred the least invasive treatment, but given the large endocardial mass size and recurrent strokes, the decision was to do MVR. The choice of bioprosthetic versus mechanical valve in LSE remains controversial. Therefore, multiple factors were considered before proceeding with a bioprosthetic valve. A multidisciplinary team from six specialties was involved with her care. This case highlights the challenges in managing LSE in a young patient with cognitive delay and comorbidities. Individualized decision-making, involving careful consideration of life circumstances and patient preference, led to a successful outcome with bioprosthetic mitral valve replacement. This case emphasizes the importance of a tailored approach in complex cardiac conditions.