ETIOLOGY AND MANAGEMENT OF CHRONIC VALVE DISEASE IN ANTIPHOSPHOLIPID ANTIBODY SYNDROME AND SYSTEMIC LUPUS-ERYTHEMATOSUS

Unlike the Libman-Sacks vegetations of acute systemic lupus erythemato sus (SLE), which are usually asymptomatic, valve involvement in chroni c SLE and primary antiphospholipid antibody syndrome (APLAS) is simila r to that of chronic rheumatic disease. Typical findings include valve thickening and nodularity, poor coaptation, and regurgitation. Elevat ed levels of antiphospholipid antibodies have been associated with the development of these valvular abnormalities in some but not all repor ted cases, and there undoubtedly other etiologic cofactors. When cardi ac valvular replacement is required, special attention must be given t o preoperative reduction of elevated antibody levels, prevention of in traoperative thromboembolism, and prompt and aggressive postoperative anticoagulation.