Libman-Sacks endocarditis

Description

Libman-Sacks endocarditis, characterized by sterile, verrucous valvular lesions (Libman-Sacks vegetations) with a predisposition for the mitral and aortic valves.

Libman-Sacks endocarditis is regarded as both a cardiac manifestation of systemic lupus erythematosus and, in recent years, of the antiphospholipid syndrome (APS). It is commonly complicated with embolic cerebrovascular disease.

Libman-Sacks vegetations: sterile fibrofibrinous vegetations that favor the left-sided heart valves and usually form on the ventricular surface of the mitral valve. A study of the echocardiographic findings of 342 consecutive patients with SLE found that 11% of these patients had Libman-Sacks vegetations

History

1924 – Emanuel Libman and Benjamin Sacks, in which they characterized non-bacterial verrucous valvular disease in four patients with SLE

1985 – Association between Libman–Sacks endocarditis and antiphospholipid syndrome first reported. First report, a female with SLE, positive lupus anticoagulant, and verrucous endocarditis

Associated Persons

• Emanuel Libman (1872 – 1946)
• Benjamin Sacks (1896 – 1971)

Alternative names

• Atypical verrucous endocarditis 
• Libman-Sacks vegetations

References

• Libman E, Sacks B. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med. 1924;33(6): 701–737
• Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med. 2007 Jul;120(7):636-42. [PMID 17602939]
• Roldan CA et al. Libman-Sacks Endocarditis: Detection, Characterization, and Clinical Correlates by Three-Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr. 2015 Jul;28(7):770-9. [PMC4592775]
• Hojnik M, George J, Ziporen L, Shoenfeld Y. Heart valve involvement (Libman-Sacks endocarditis) in the antiphospholipid syndrome. Circulation. 1996 Apr 15;93(8):1579-87. [PMID 8608627]
• Lee JL, Naguwa SM, Cheema GS, Gershwin ME. Revisiting Libman-Sacks endocarditis: a historical review and update. Clin Rev Allergy Immunol. 2009 Jun;36(2-3):126-30. [PMID 19089657]
• Doherty NE, Siegel RJ. Cardiovascular manifestations of systemic lupus erythematosus. Am Heart J. 1985 Dec;110(6):1257-65. [PMID 3907317]