Revisiting Libman-Sacks endocarditis: A historical review and update

Libman-Sacks (LS) endocarditis was first described by Libman and Sacks in 1924, and is characterized by sterile, verrucous valvular lesions with a predisposition for the mitral and aortic valves. It is now regarded as both a cardiac manifestation of systemic lupus erythematosus and, in recent years, of the antiphospholipid syndrome (APS). Though typically mild and asymptomatic, LS endocarditis can lead to significant complications, including severe valvular insufficiency requiring surgery, infective endocarditis, and thromboembolic events, such as stroke and transient ischemic events. Improvements in imaging modalities, particularly in echocardiography, have allowed better estimation of the prevalence of the disease, but further investigation is still needed into its pathogenesis, treatment, and association with APS.