Atypical verrucous endocarditis of Libman-Sacks is found at autopsy in up to 40% of patients with SLE.
Fibrofibrinous, sterile vegetations most commonly occur on the undersurface of the mitral valve but may develop on either surface of any of the four cardiac valves. The lesions are similar to those found in marantic endocarditis except that in Libman-Sacks, focal necrosis of the valve leaflets may occur.
Usually, the verrucae are clinically silent. Valvular dysfunction, particularly mitral or aortic regurgitation, is most often associated with the healed form of the lesion, the fibrous plaque. However, the presence or absence of murmurs, correlates poorly with autopsy findings. The lesions present an increased risk of infective endocarditis.
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