Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus
A 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. S...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2016/3250845 |
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| author | Siddharth Wartak Isaac Akkad Adnan Sadiq Gregory Crooke Manfred Moskovits Robert Frankel Gerald Hollander Jacob Shani |
| author_facet | Siddharth Wartak Isaac Akkad Adnan Sadiq Gregory Crooke Manfred Moskovits Robert Frankel Gerald Hollander Jacob Shani |
| author_sort | Siddharth Wartak |
| collection | DOAJ |
| description | A 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. She underwent a bioprosthetic mitral valve replacement (MVR) at outside hospital. However, within a year of her surgery, she presented to our hospital with NYHA class IV symptoms. She was treated for heart failure but in view of her persistent symptoms and low EF was considered for heart and kidney transplant. This was a challenge in view of her history of lupus. We presumed that her stenosis of bioprosthetic valve was secondary to lupus and renal disease. We hypothesized that her low ejection fraction was secondary to mitral stenosis and potentially reversible. We performed a dobutamine stress echocardiogram, which revealed an improved ejection fraction to more than 50% and confirmed preserved inotropic contractile reserve of her myocardium. Based on this finding, she underwent a metallic mitral valve and tricuspid valve replacement. Following surgery, her symptoms completely resolved. This case highlights the pathophysiology of lupus causing stenosis of prosthetic valves and low ejection cardiomyopathy. |
| format | Article |
| id | doaj-art-66c7653b64ba4fa89bcff08e194f4829 |
| institution | Kabale University |
| issn | 2090-6404 2090-6412 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Cardiology |
| spelling | doaj-art-66c7653b64ba4fa89bcff08e194f48292025-02-03T06:11:07ZengWileyCase Reports in Cardiology2090-64042090-64122016-01-01201610.1155/2016/32508453250845Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus ErythematosusSiddharth Wartak0Isaac Akkad1Adnan Sadiq2Gregory Crooke3Manfred Moskovits4Robert Frankel5Gerald Hollander6Jacob Shani7Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USADepartment of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USADepartment of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USADepartment of Interventional Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USADepartment of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USADepartment of Interventional Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USADepartment of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USADepartment of Interventional Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USAA 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. She underwent a bioprosthetic mitral valve replacement (MVR) at outside hospital. However, within a year of her surgery, she presented to our hospital with NYHA class IV symptoms. She was treated for heart failure but in view of her persistent symptoms and low EF was considered for heart and kidney transplant. This was a challenge in view of her history of lupus. We presumed that her stenosis of bioprosthetic valve was secondary to lupus and renal disease. We hypothesized that her low ejection fraction was secondary to mitral stenosis and potentially reversible. We performed a dobutamine stress echocardiogram, which revealed an improved ejection fraction to more than 50% and confirmed preserved inotropic contractile reserve of her myocardium. Based on this finding, she underwent a metallic mitral valve and tricuspid valve replacement. Following surgery, her symptoms completely resolved. This case highlights the pathophysiology of lupus causing stenosis of prosthetic valves and low ejection cardiomyopathy.http://dx.doi.org/10.1155/2016/3250845 |
| spellingShingle | Siddharth Wartak Isaac Akkad Adnan Sadiq Gregory Crooke Manfred Moskovits Robert Frankel Gerald Hollander Jacob Shani Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus Case Reports in Cardiology |
| title | Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus |
| title_full | Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus |
| title_fullStr | Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus |
| title_full_unstemmed | Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus |
| title_short | Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus |
| title_sort | severe bioprosthetic mitral valve stenosis and heart failure in a young woman with systemic lupus erythematosus |
| url | http://dx.doi.org/10.1155/2016/3250845 |
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