A Case of Severe Mitral Stenosis due to Libman-Sacks Endocarditis

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe mitral stenosis due to Libman-Sacks endocarditis (n=1). Intervention: Mitral valve replacement.

Q: What does this research mean for the field?

Libman-Sacks endocarditis associated with systemic lupus erythematosus and antiphospholipid syndrome can lead to severe mitral stenosis and thromboembolic complications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Naoto Yoshida; Natsuko Mukai-Yatagai; 菜津実 福本; Yoshiharu Kinugasa; Hiroshi Ishii; Tomoya Harada; Naoki Sumi; Akira Yamasaki; Yasushi Yoshikawa; Kazuhiro Yamamoto

doi:10.2169/naika.114.1968

October 10, 2025Nihon Naika Gakkai ZasshiOpen Access

A Case of Severe Mitral Stenosis due to Libman-Sacks Endocarditis

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Why the study?

Libman-Sacks endocarditis associated with SLE and APS can cause valvular disease and thromboembolism, but severe mitral stenosis requiring surgery is rare and requires attention.

Key Points

To describe a rare presentation of severe mitral stenosis requiring surgical valve replacement in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome.
Clinical evaluation, transthoracic and transesophageal echocardiography, and brain MRI were performed in a 33-year-old woman with recurrent stroke and exertional dyspnea (N=1).
Surgical bioprosthetic mitral valve replacement was executed following immunosuppressive therapy with prednisolone, followed by histopathological examination of the excised valve.
Echocardiography demonstrated severe mitral stenosis with extensive leaflet fusion, a valve area of 0.98 cm² on transthoracic trace (0.52 cm² on 3D transesophageal imaging), and a mean pressure gradient of 10 mmHg.
Histopathology confirmed Libman-Sacks endocarditis characterized by surface sterile verrucae and elastic fiber disruption without bacterial infection.
Following bioprosthetic valve replacement and anticoagulation with warfarin and aspirin, the patient achieved a favorable postoperative recovery.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 33-year-old female with systemic lupus erythematosus and antiphospholipid syndrome who developed severe mitral stenosis due to Libman-Sacks endocarditis and underwent surgical valve replacement.

I

Intervention

Surgical mitral valve replacement with a bioprosthesis, along with medical management including prednisolone, warfarin (for 3 months post-op), and aspirin.

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Implication

This case highlights that Libman-Sacks endocarditis in patients with SLE and antiphospholipid syndrome can, although rarely, present as severe mitral stenosis requiring surgical valve replacement.

Abstract

33歳女性．20歳代より複数の抗リン脂質抗体陽性を認め，再発性脳梗塞を発症．精査の結果，抗リン脂質抗体症候群（APS）合併全身性エリテマトーデス（SLE）と診断した．労作時呼吸苦の精査で重度の僧帽弁狭窄症が判明し，僧帽弁置換術を施行．病理所見でLibman-Sacks（LS）心内膜炎と診断した．SLEやAPSにおけるLS心内膜炎は弁膜症，血栓塞栓症の原因となり注意が必要である．

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Cite This Study

Yoshida et al. (2025) conducted a case report in Severe mitral stenosis due to Libman-Sacks endocarditis (n=1). Mitral valve replacement was evaluated.

synapsesocial.com/papers/6acc29b9005c34d980820f20 https://doi.org/10.2169/naika.114.1968

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A Case of Severe Mitral Stenosis due to Libman-Sacks Endocarditis

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Case of Severe Mitral Stenosis due to Libman-Sacks Endocarditis

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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