Libman-Sacks endocarditis (LSE) is a nonbacterial endocarditis associated with lupus, malignancy, and antiphospholipid antibody syndrome characterized by endothelial injury and immune complex deposition typically on left-heart valves (mitral > aortic) causing inflammation and scarring.
Unfortunately, symptoms are usually related to embolic sequelae such as stroke, abdominal pain related to gut ischemia, or peripheral embolism causing limb ischemia. Controlling the underlying disease process (immunomodulation, anti-inflammatories, etc.) is critical, and a subset of patients will require procedures to address valvulopathies.
In this transesophageal echocardiogram, simultaneous mid-esophageal short and long-axis views of the aortic valve (AoV) demonstrate thick, restricted leaflets resulting in both AoV stenosis and insufficiency. Typically, the vegetations of LSE (as seen on this AoV’s left coronary cusp) are irregular with heterogeneous echogenicity.