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Olivares-Reyes Alexander, Al-Kamme Ahmad
Cardiology Department, The Brooklyn Hospital
Center, Brooklyn, New York,
and The Edward W. McCready Memorial Hospital, Crisfield, Maryland, USA
Objectives: Evaluate the effect of Systemic Lupus Erithematosus (SLE) over the aortic valve and its cardiovascular implication.
Background: No part of the heart is exempt from SLE. This may affect the pericardium, endocardium, myocardium, conducting system, and coronary arteries. The valve most commonly affected is the mitral, but aortic valve is also affected. Aortic incompetence is a rare finding in SLE, reported from 0% to 7%. Pure aortic insufficiency (PAI), due to SLE is still more infrequent.
Material and Methods: We reviewed all charts of patients with the diagnosis of SLE and we found only two that had PAI as the unique valvulopathy present attributed to SLE. The diagnosis of SLE was made using the 1982 ARA criteria. The literature was also reviewed and we found 16 well documented cases of PAI attributed to SLE. The 18 cases were exhaustively analyzed as a group.
Results: The female/male ratio was 1.6 : 1 (11/7), 61% and 39% respectively. The age mean was 37 years. The cardiovascular complications included: heart failure 67%, arterial hypertension 56%, and pericarditis 33%. Fourteen patient (78%) had renal involvement and 10 (56%) developed renal failure. Twelve patients were treated medically (67%) and six (33%) underwent valvular replacement. Mortality occurred in five patients (28%), all of them in heart failure. In the medical group 33% (4/12 patients) died, in the surgical group only 17% (1/6 patients) expired.
Discussion: We analyzed the clinical aspects, treatment, and outcome of this particular group.
1) Systemic Lupus Erithematosus is an additional cause of aortic insufficiency,
2) Survival in these patients has improved in the last three decades, probably due to the new therapeutic armamentaria available, and the earlier and better surgical procedures,
3) The main cause of death in these patients with PAI is a chronic and irreversible congestive heart failure.
2nd Virtual Congress of Cardiology
Dr. Florencio Garófalo
Dr. Raúl Bretal
Dr. Armando Pacher
Technical Committee - CETIFAC
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