Libman-Sacks Endocarditis Due to Systemic Lupus Erythematosus Activation After Mitral Valve Plasty Takaaki Samura, MD, Koichi Toda, MD, PhD, Daisuke.

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Libman-Sacks Endocarditis Due to Systemic Lupus Erythematosus Activation After Mitral Valve Plasty Takaaki Samura, MD, Koichi Toda, MD, PhD, Daisuke Yoshioka, MD, Teruya Nakamura, MD, PhD, Shigeru Miyagawa, MD, PhD, Yasushi Yoshikawa, MD, PhD, Shunsuke Saito, MD, PhD, Keitaro Domae, MD, Yoshiki Sawa, MD, PhD The Annals of Thoracic Surgery Volume 104, Issue 2, Pages e109-e111 (August 2017) DOI: 10.1016/j.athoracsur.2017.01.073 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Intraoperative photos of the first operation show enlargement of the mitral annulus, deep cleft between P2 and P3, and mild calcification of A2, which was decalcified (orange arrows). (B) Photomicrograph of section of mitral valve leaflet demonstrates normal valve without deposition of fibrin. (Hematoxylin and eosin; ×40.) The Annals of Thoracic Surgery 2017 104, e109-e111DOI: (10.1016/j.athoracsur.2017.01.073) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative photos of the second operation show (left) a mitral valve with multiple small vegetations of Libman-Sacks endocarditis and (right) an excised mitral anterior leaflet with wartlike vegetations. The Annals of Thoracic Surgery 2017 104, e109-e111DOI: (10.1016/j.athoracsur.2017.01.073) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Photomicrograph shows section of mitral valve leaflet with deposition of fibrin and small collections of neutrophils and monocytes, but no bacterial colonies. (Hematoxylin and eosin; ×40). The Annals of Thoracic Surgery 2017 104, e109-e111DOI: (10.1016/j.athoracsur.2017.01.073) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions