{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T21:11:18Z","timestamp":1775077878059,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T00:00:00Z","timestamp":1724889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>Recurrence of valvular involvement may occur after Libman\u2013Sacks endocarditis surgery, emphasizing the need for frequent multivalvular evaluations with echocardiography or more sensitive methods to optimize surgical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>This report presented a 32\u2010year\u2010old woman, complaining of recurrent fever and chills. Physical examination revealed the presence of a third heart sound (S<jats:sub>3<\/jats:sub>), a pan\u2010systolic murmur (III\/VI) at mitral and tricuspid foci, tachycardia, and fine pulmonary crackles. Transesophageal echocardiography (TEE) revealed severe mitral regurgitation (MR) and moderate tricuspid regurgitation (TR) with vegetations on the mitral valve. Initially, intravenous antibiotic therapy was started simultaneously with diagnostic studies. Despite a positive TEE, negative blood cultures on three separate occasions precluded meeting the diagnostic criteria outlined in the modified Duke criteria. Moreover, the patient's condition continued to deteriorate after antibiotic therapy, leading to the diagnosis of Libman\u2013Sacks endocarditis. The patient was considered a candidate for mitral valve surgery. All vegetations were completely debrided and then the mitral valve was reconstructed. Follow\u2010up post\u2010surgery echocardiography revealed the absence of MR and mitral stenosis (MS). Four months later, the patient presented again complaining of fatigue, dyspnea, lower extremity edema, and ascites with evidence of pulmonary hypertension and right heart failure on physical examination. TEE was performed, which revealed severe MR, severe TR, detached artificial chordae, and blood leak from the perforated pericardial patch. Therefore, she was necessitated for valvular surgery and underwent mitral and tricuspid valve surgery. The mitral ring and perforated pericardial patch were removed, and a mitral prosthetic valve was implanted. In addition, the tricuspid valve was repaired. Follow\u2010up post\u2010surgery echocardiography revealed the absence of MR and TR. To our knowledge, this is the first case of LSE recurrence with multi\u2010valvular involvement.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.9352","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T04:24:00Z","timestamp":1724991840000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Recurrence of valvular involvement in Libman\u2013Sacks endocarditis associated with antiphospholipid syndrome: A case report"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3855-192X","authenticated-orcid":false,"given":"Shahab","family":"Masoumi","sequence":"first","affiliation":[{"name":"Cardiovascular Research Center Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4492-637X","authenticated-orcid":false,"given":"Razieh","family":"Parizad","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2829-252X","authenticated-orcid":false,"given":"Rezayat","family":"Parvizi","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7677-8458","authenticated-orcid":false,"given":"Amirreza","family":"Jabbaripour\u00a0Sarmadian","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5431-3860","authenticated-orcid":false,"given":"Samira","family":"Jafarisis","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6782-8342","authenticated-orcid":false,"given":"Kia","family":"Seyed\u00a0Toutounchi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,29]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Libman Sacks Endocarditis","author":"Ibrahim AM","year":"2018"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-008-8113-y"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203320930097"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2019.12.008"},{"issue":"10","key":"e_1_2_13_6_1","first-page":"981","article-title":"Infectious endocarditis: diagnosis and treatment","volume":"85","author":"Pierce D","year":"2012","journal-title":"Am Fam 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management.2023;380:e069717.","DOI":"10.1136\/bmj-2021-069717"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.00941"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1692702"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1117711"},{"issue":"4","key":"e_1_2_13_19_1","article-title":"Libman\u2010sacks endocarditis with triple valvular involvement","volume":"15","author":"Asher Syed M","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.8597"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac315"}],"container-title":["Clinical Case 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