Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature

Libman-Sacks endocarditis of the mitral valve was first described by Libman and Sacks in 1924. Currently, the sterile verrucous vegetative lesions seen in Libman-Sacks endocarditis are regarded as a cardiac manifestation of both systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). Although typically mild and asymptomatic, complications of Libman-Sacks endocarditis may include superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery. In this study we report two cases of mitral valve repair and two cases of mitral valve replacement for mitral regurgitation (MR) caused by Libman-Sacks endocarditis. In addition, we provide a systematic review of the English literature on mitral valve surgery for MR caused by Libman-Sacks endocarditis. This report shows that mitral valve repair is feasible and effective in young patients with relatively stable SLE and/or APS and only localized mitral valve abnormalities caused by Libman-Sacks endocarditis. Both clinical and echocardiographic follow-up after repair show excellent mid- and long-term results

Vanishing Clams on an iberian beach: local consequences and global implication of accelerating loss of shells to tourism

Multi-decadal increase in shell removal by tourists, a process that may accelerate degradation of natural habitats, was quantified via two series of monthly surveys, conducted thirty years apart (1978-1981 and 2008-2010) in one small embayment on the Mediterranean coast of Spain. Over the last three decades, the local tourist arrivals have increased almost three-fold (2.74), while the area has remained unaffected by urban encroachment and commercial fisheries. Concomitantly, abundance of mollusk shells along the shoreline decreased almost three-fold (2.62) and displayed a tight inverse correlation with tourist arrivals. A four-fold increase in tourist arrivals observed globally over the last 30 years has likely induced a comparable worldwide acceleration in shell removal from marine shorelines and exerted multiple negative (but currently unquantifiable) habitat changes that may include increased beach erosion, changes in carbon and calcium cycles, and decline in diversity and abundance of organisms dependent on shell availability