A case report of an unusual cause of mitral stenosis in a young woman

Figures

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  Figure 1. Two- and three-dimensional rest echocardiographical images from 2006 (baseline) to 2015 (follow-up) in a patient with systemic lupus erythematosus and progressive Libman Sacks endocarditis. (A, B, D, and E) Mitral valve area by planimetry of three- and two-dimensional planes in short axis are shown. (F) Reduced maximal diastolic opening (also see Supplementary material online, Video S2) with nodular thickening in 2015 compared with 2006 (C, see Supplementary material online, Video S3) on an apical four-chamber view is shown.

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  Figure 2. Bicycle echocardiography in 2015 at rest and during peak stress (100 W). Images show tricuspid regurgitant flow velocities (A and C) and continuous wave Doppler mitral velocities (B and D). Mean mitral valve gradient became much higher at peak stress (mean 34 vs. 6 mmHg) (D vs. B) with a significant increase in systolic pulmonary pressure (67 mmHg compared with 40 mmHg at rest) (C vs. A).

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  Figure 3. The excised mitral valve macroscopic view (A) shows the chordae tendineae (*) and mitral valve. Microscopic examination (B) shows the presence of distrophic calcifications (**) and strong widened collagen connective tissue and hyalinization. (C) neovascularization (typical for lupus) and chronic inflammation with plasma cells infiltration is shown. Haematoxylin and eosin stain, original magnification at ×10 (A), ×50 (B), and ×310 (C).