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      Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report

      case-report

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          Abstract

          Background

          Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with thrombotic events, myocardial infarction, and valvular heart disease. During valvular replacement surgery, the high risk of thrombosis combined with the operative risks in these specific groups of patients poses a challenge to the medical team.

          Case presentation

          We present a case of a female patient with APS and mixed aortic valve disease. During surgery, she suddenly developed complete cardiac arrest. Three months later, after she recovered, and while she was still on close follow up, a thrombotic event caused myocardial infarction. After prompt and precise treatment, the patient successfully recovered; one year after surgery patient is doing well.

          Conclusion

          Adequate surgical technique along with optimal anticoagulation strategies and long term follow up are of paramount importance to ensure an uneventful recovery. A multidisciplinary team is required to manage these complex scenarios and high-risk patients.

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          Most cited references22

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          Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis

          The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial.
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            The CARE guidelines: consensus-based clinical case reporting guideline development.

            A case report is a narrative that describes, for medical, scientific or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Develop, disseminate and implement systematic reporting guidelines for case reports. We used a three-phase consensus process consisting of (1) premeeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines and (3) postmeeting feedback, review and pilot testing, followed by finalisation of the case report guidelines. This consensus process involved 27 participants and resulted in a 13-item checklist-a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective and informed consent. We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery.
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              Valvular heart disease in antiphospholipid syndrome.

              Heart valve disease (HVD) is the most frequent cardiac manifestation in patients with antiphospholipid syndrome (APS), with prevalence of 30 %. The definition is based on the presence of thickening or vegetation of the valves (mainly mitral and aortic) as described by Libman and Sacks for patients with systemic lupus erythematosus (SLE). Transthoracic and/or transoesophageal echocardiography (TTE and TEE, respectively) enable early and accurate diagnosis and help avoid misdiagnosis as rheumatic valve disease. The presence of antiphospholipid antibodies (aPL) in SLE patients is associated with a threefold greater risk of HVD, confirming the crucial importance of these antibodies in the pathogenic process, leading to thrombotic manifestations on valves because of hypercoagulability. Natural history is characterized by worsening of HVD over time with an increased risk for stroke. APS patients undergoing valve-replacement surgery are at high risk of thrombotic and bleeding complications. Thus aPL-associated HVD has affects clinical management of APS patients.
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                Author and article information

                Contributors
                drsantiagoendara@gmail.com
                gadavalos@hotmail.com
                cfierro1967@gmail.com
                cmdrullauri@gmail.com
                gabomolina32@gmail.com
                Journal
                J Cardiothorac Surg
                J Cardiothorac Surg
                Journal of Cardiothoracic Surgery
                BioMed Central (London )
                1749-8090
                29 September 2020
                29 September 2020
                2020
                : 15
                : 275
                Affiliations
                [1 ]GRID grid.414834.e, ISNI 0000 0004 0374 9308, Department of Surgery Division of Cardiothoracic Surgery, , Hospital Metropolitano, ; Av. Mariana de Jesús Oe7/47 y Conclina, Edificio Diagnóstico 2000 tercer piso 3/3, Quito, Ecuador
                [2 ]GRID grid.414834.e, ISNI 0000 0004 0374 9308, Department of Internal Medicine Division of Cardiology, , Hospital Metropolitano, ; Quito, Ecuador
                [3 ]GRID grid.412251.1, ISNI 0000 0000 9008 4711, Colegio de Ciencias de la Salud, , Universidad San Francisco de Quito (USFQ), ; Quito, Ecuador
                Article
                1330
                10.1186/s13019-020-01330-9
                7526220
                32993710
                542b545d-f29e-4486-93d2-de7b41910613
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 28 May 2020
                : 22 September 2020
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2020

                Surgery
                antiphospholipid syndrome,thrombus,coronaries arteries,aortic valve replacement
                Surgery
                antiphospholipid syndrome, thrombus, coronaries arteries, aortic valve replacement

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