MITRAL-INSUFFICIENCY CAUSED BY SYSTEMIC LUPUS-ERYTHEMATOSUS REQUIRINGVALVE-REPLACEMENT - 3 CASE-REPORTS AND A REVIEW OF THE LITERATURE

The increase of mitral valve insufficiency associated with systemic lu pus erythematosus (SLE) seems to be related to the treatment with cort icosteroids. Corticosteroids heal Libman-Sacks endocarditis, but there by they lead to fibrotic, retracted leaflet tissue and thus to severe valvular dysfunction. We present three patients with SLE who unterwent mitral valve replacement due to severe mitral insufficiency. All had been treated with corticosteroids for several years prior to the surgi cal intervention. Macroscopic and microscopic examination of the valve s revealed no active endocarditis. Instead, fibrotic, retracted, and c alcified 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 uneve ntful in most cases and allows surgical intervention to be considered as a feasible treatment without major risk in patients with compensate d organ function.