Mitral Insufficiency Caused by Systemic Lupus Erythematosus Requiring Valve Replacement: Three Case Reports and a Review of the Literature

The increase of mitral valve insufficiency associated with systemic lupus erythematosus (SLE) seems to be related to the treatment with corticosteroids. Corticosteroids heal Libman-Sacks endocarditis, but thereby they lead to fibrotic, retracted leaflet tissue and thus to severe valvular dysfunction. We present three patients with SLE who underwent mitral valve replacement due to severe mitral insufficiency. All had been treated with corticosteroids for several years prior to the surgical intervention. Macroscopic and microscopic examination of the valves revealed no active endocarditis. Instead, fibrotic, retracted, and calcified valve leaflets could be observed in two cases, and ballooned and fibrotic leaflets in the third case. We compare our patients to 25 cases with SLE reported in the literature so far, who also had to be submitted to mitral valve replacement. Postoperative outcome was uneventful in most cases and allows surgical intervention to be considered as a feasible treatment without major risk in patients with compensated organ function.