Valvular Heart Disease In Antiphospholipid Syndrome (Review)

The review concerns special aspects of valvular heart disease (VHD) in antiphospholipid syndrome (APS). In addition to epidemiological data and classification criteria for APS, information is provided on the prevalence, pathogenetic mechanisms, and pathomorphological features of VHD, which is characterized by verrucous endocarditis (or Libman-Sacks endocarditis), thickening of the leaflets and valve dysfunction. The main pathogenetic events of VHD are caused by the effects of antiphospholipid antibodies, local platelet aggregation, migration of inflammatory cells and deposition of immune complexes. The course of VHD in APS is often complicated by thromboembolic complications, including embolization of the cerebral arteries and coronary arteries. Diagnosis of VHD in APS is based primary on the results of echocardiography, which allows to identify leaflet thickening, verrucous vegetations and assess the function of the valve apparatus. The use of transesophageal echocardiography makes it possible to clarify the features of valvular lesions in case of inconclusive results of transthoracic echocardiography. The issues of management of patients with and VHD are discussed, with an assessment of the results of the use of antiplatelet, anticoagulant, immunosuppressive therapy and surgical correction of severe valvular pathology. Cardiac surgery is associated with an increased risk of postoperative complications due to bleeding or thrombosis, as well as mortality.