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Valvular Heart Disease in the Primary Antiphospholipid Syndrome

Enrique Galve, MD; Josep Ordi, MD; Jordi Barquinero, MD; Arturo Evangelista, MD; Miquel Vilardell, MD; and J. Soler-Soler, MD
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This paper was presented in part at the annual meeting of the American Heart Association, Dallas, Texas, November 1990, and results were reported in abstract form in Circulation (1990;82[III]:397).

Requests for Reprints: Enrique Galve, MD, Servicio de Cardiología, Departamento de Medicine, Hospital General Universitari Vall d'Hebron, Paseo Vall d'Hebron s/n, 08035 Barcelona, Spain.

Current Author Addresses: Drs. Galve, Ordi, Barquinero, Evangelista, Vilardell, and Soler-Soler: Servicio de Cardiología y Departamento de Medicina, Hospital General Universitari Vall d'Hebron, Paseo Vall d'Hebron s/n, 08035 Barcelona, Spain.

©1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(4):293-298. doi:10.7326/0003-4819-116-4-293
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Objective: To determine the prevalence of cardiac valvular involvement in patients with the primary antiphospholipid syndrome.

Design: Cross-sectional study with evaluation of case patients and control patients by Doppler echocardiography. The mean follow-up for case patients was 21 months.

Setting: University-based tertiary medical center.

Patients: Twenty-eight consecutive patients who were diagnosed with the primary antiphospholipid syndrome during a 10-year period; 28 age- and sex-matched healthy controls.

Measurements and Main Results: Ten patients (36%; 95% Cl, 19% to 56%) with the primary antiphospholipid syndrome had cardiac valvular involvement: Four patients had mitral valve involvement; four patients, aortic valve involvement; and two patients, both mitral and aortic valve involvement; no patients had tricuspid or pulmonary valve disease. Eight of 10 patients had a regurgitant murmur. None of the control patients had valvular disease. The mean mitral valve thickness in patients with mitral valve involvement was 7.0 ± 1.6 mm, compared with 2.7 ± 0.8 mm in patients with normal valves and 3.2 ± 0.9 mm in the control group. The mean aortic valve thickness in patients with aortic valve involvement was 3.8 ± 0.5 mm compared with 1.4 ± 0.3 mm in patients with normal valves and 1.4 ± 0.5 mm in the control group. Stenotic lesions were not found. Regurgitation was severe in two patients (one required surgery), moderate in three patients, and mild in three patients.

Conclusions: Valvular involvement is frequently found in patients with the primary antiphospholipid syndrome. The lesions are left-sided, causing regurgitation that may be clinically important.





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