Aortic root and coronary ostium involvement in Libman-Sacks endocarditis: a rare caseRare Heart Complications Found in Patient with Lupus and Syndrome

Frontiers in Medicine Published August 28, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider aortic root and coronary ostial involvement in Libman-Sacks endocarditis, as this case illustrates a rare but life-threatening presentation.

This case report describes a 25-year-old woman with systemic lupus erythematosus and antiphospholipid syndrome who presented with Libman-Sacks endocarditis. The report details a large endocarditic mass arising from the aortic valve leaflet, which also involved the aortic root and obstructed the right coronary ostium. The patient underwent successful resection and valve replacement.

The authors emphasize that aortic root involvement with coronary ostial obstruction in Libman-Sacks endocarditis has not been previously reported. This case illustrates the heterogeneous and potentially life-threatening nature of Libman-Sacks endocarditis, extending beyond typical valvular involvement.

As a single case report, the findings are anecdotal and cannot be generalized. No data on follow-up, adverse events, or long-term outcomes are provided. The report does not include information on funding or conflicts of interest.

For clinicians, this case underscores the importance of considering aortic root and coronary ostial involvement in patients with Libman-Sacks endocarditis, especially when symptoms suggest myocardial ischemia. However, given the rarity and lack of comparative data, management should be individualized and based on multidisciplinary assessment.

How this fits prior evidence

This case report extends prior coverage of lupus-related complications by highlighting a rare and severe manifestation of Libman-Sacks endocarditis. While previous items addressed lupus nephritis and CAR T-cell therapy for SLE, this case focuses on cardiac involvement, specifically aortic root and coronary ostial obstruction. It underscores the heterogeneity of SLE manifestations, complementing earlier findings on mucocutaneous indicators and genetic risk factors. The report does not confirm or contrast prior findings but adds a new clinical dimension to the spectrum of SLE-related organ involvement.

A medical report describes a 25-year-old woman who had both Systemic Lupus Erythematosus and Antiphospholipid Syndrome. During medical evaluation, she was found to have Libman-Sacks endocarditis, which is a type of heart inflammation. The report highlights that her condition involved a large mass on the aortic valve and a blockage of the right coronary ostium.

The patient underwent surgery involving resection and valve replacement. The procedure was successful in addressing the physical blockages. This case is significant because it highlights how complex and varied heart complications can be for patients with these specific autoimmune conditions.

Because this is a single case report involving only one patient, the findings are not enough to establish general trends or standard treatments. It serves as a specific example of rare complications that can occur in certain patients. Patients with these conditions should continue to work closely with their doctors to monitor heart health.

What this means for you:

A single case shows that some patients with lupus and antiphospholipid syndrome may develop rare heart valve issues.

Common questions

What specific heart issues were found in this patient?

The patient had a large endocarditic mass on the aortic valve leaflet and an obstruction of the right coronary ostium. These findings are part of Libman-Sacks endocarditis, which can occur in people with Systemic Lupus Erythematosus and Antiphospholipid Syndrome.

Was the surgery successful for the patient?

The report states that the resection and valve replacement were successful. This procedure was used to address the aortic valve involvement and the coronary ostium obstruction found during the medical evaluation.

How common are these specific heart complications?

The report notes that aortic root involvement with coronary ostial obstruction in Libman-Sacks endocarditis has not been previously reported. This makes it a very rare finding in patients with these specific conditions.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedAug 2026

View Original Abstract ↓

BackgroundLibman-Sacks (LS) endocarditis, a nonbacterial thrombotic endocarditis, is the most frequent cardiac manifestation of systemic lupus erythematosus (SLE), particularly when associated with antiphospholipid syndrome (APS). It usually involves the mitral valve and is often clinically silent.Case summaryWe present a 25-year-old woman with SLE and APS who developed acute hemodynamic deterioration. Urgent surgery revealed a large endocarditic mass arising from the aortic valve leaflet, extending to the aortic root and obstructing the right coronary ostium. Resection and valve replacement were performed successfully.DiscussionUnlike typical LS endocarditis, which manifests as mild valvular lesions, this case demonstrates rare aortic root involvement with coronary ostial obstruction. A review of the literature confirms that such an extension has not been previously reported, underscoring the heterogeneous and potentially life-threatening nature of LS endocarditis.Take home messagesLS endocarditis can present atypically. Recognition of unusual patterns is critical for timely intervention.

Aortic root and coronary ostium involvement in Libman-Sacks endocarditis: a rare caseRare Heart Complications Found in Patient with Lupus and Syndrome

How this fits prior evidence

Common questions

Study Details

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Aortic root and coronary ostium involvement in Libman-Sacks endocarditis: a rare caseRare Heart Complications Found in Patient with Lupus and Syndrome

How this fits prior evidence

Common questions

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Study Details

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Clinical research that matters. Delivered to your inbox.

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