Multiple organ dysfunction after mitral valve replacement in a patient with systemic lupus erythematosus complicated by Libman-Sacks endocarditis: a case report and literature review

This case report describes a 47-year-old woman with systemic lupus erythematosus (SLE) complicated by Libman-Sacks endocarditis (LSE) who developed multiple organ dysfunction after mitral valve replacement surgery. The patient presented with a 5-day history of cough, sputum, and fever. Transthoracic echocardiography showed significant vegetations on the mitral valve. Biopsy was performed, and the pathological diagnosis was SLE complicated by LSE. After the mitral valve replacement surgery, the patient developed clinical manifestations of hepatic and renal dysfunction, cardiopulmonary failure, oliguria, and shock. The clinical symptoms significantly improved after administration of mechanical ventilation, continuous renal replacement therapy, plasma exchange, anti-inflammatory and anti-infection treatments, immunomodulatory and immunosuppressive therapies, and low-molecular-weight heparin anticoagulation. Multiple organ dysfunction after mitral valve replacement in patients with SLE complicated by LSE has rarely been reported. This report discusses the clinical manifestations, pathogenesis, and treatment of this severe complication. We hope the sharing of our experience in this case will provide a clinical basis for the treatment of severe multiple organ dysfunction after mitral valve replacement in patients with SLE complicated by LSE.

[Effects of berberine on ischemic ventricular arrhythmia]

The effects of berberine on ischemic ventricular arrhythmias induced by ligating the left anterior descending coronary artery (LAD) of canine were reported. The results showed that berberine was able to get 99% suppression (P less than 0.001) on the total ventricular premature beats (VPCs) by 12 hours after ligature of LAD, the paired VPCs, ventricular tachycardias and VPCs with R on T were also significantly suppressed; and the ventricular tachycardia induced by programmed ventricular stimulation was effectively inhibited by berberine. In addition, the results revealed that the decrease of cardiac output caused by ligature of LAD was obviously attenuated by berberine. The mechanisms of the antiarrhythmic effect of berberine on ischemic ventricular tachyarrhythmias were discussed.