• Michael Dietrich, Melanie Bois, Renan Ferrufino, Fred Cobey, and Rekha Mankad.
• Mayo Clinic Rochester, Rochester, MN. Electronic address: Dietrich.michael@mayo.edu.
• J. Cardiothorac. Vasc. Anesth. 2020 Dec 1; 34 (12): 3462-3466.

AbstractPatients with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLAS) are at risk for cardiac manifestations, specifically valvular heart disease requiring valve replacement. Bioprosthetic valve endocarditis is an important cause of valve failure, and it is important to keep a wide differential, especially in patients with preexisting SLE and APLAS. In this E-challenge, 2 cases of bioprosthetic aortic valve endocarditis are presented; 1 case describes infective bacterial endocarditis on an aortic prosthesis and the second describes a patient with SLE and APLAS who developed bioprosthetic valve obstruction secondary to vegetations, consistent with nonbacterial endocarditis and thrombus. Etiologies for bioprosthetic valve obstruction and evaluation by echocardiography are explored. The comparison between these 2 cases specifically highlights the importance of keeping a wide differential in endocarditis, prosthetic valve vegetations, and bioprosthetic valve obstruction.Published by Elsevier Inc.

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