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Eur J Cardiothorac Surg 2008;33:168-181. doi:10.1016/j.ejcts.2007.11.004
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Reviews

The antiphospholipid syndrome and heart valve surgery

Hagen Gorkia,b,*, Vitali Malinovskia, Rex D.L. Stanbridgea

a Department of Cardiothoracic Surgery, St. Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
b Department of Cardiac Surgery, Zentralklinik Robert-Koch-Allee 9, 99438 Bad Berka, Germany

Received 8 August 2007; received in revised form 22 October 2007; accepted 6 November 2007.

* Corresponding author. Address: Niedergrunstedter Weg 01, 99425 Weimar, Germany. Tel.: +49 3643 513463. (Email: Hgorki{at}aol.com).

The antiphospholipid syndrome (APLS) is a complex autoimmune disease often connected to systemic lupus erythematodes. Main features are thromboses, fetal loss and specific antibodies. The involved autoantibodies are directed against plasma proteins such as beta2glycoprotein1 (β2GPI) or prothrombin which depend on negatively charged phospholipids. Direct antibodies against phospholipids are of no importance for APLS. Clotting tests such as activated partial thromboplastin time or diluted Russell's viper venom test (dRVVT) can show a prolonged time for coagulation despite a prothrombotic state in vivo but the investigator needs awareness about disturbing phospholipid sources and other influential factors. Enzyme linked immuno sorbent assay tests for antibodies against cardiolipin, β2GPI and prothrombin are valuable solid phase tests with different specificity. Antiphospholipid, anticardiolipin or lupus anticoagulant are misnomers in connection with APLS. They are preserved as a reminiscence of the pioneering work on the way to the still not exactly revealed basics of APLS. Valve operations in APLS patients seem to be rare; a meta-analysis of 57 cases proves that the perioperative management is, at the moment, an empirical approach with high morbidity and mortality in these young patients.

Abbreviations: aCL = anticardiolipin antibodies • antiPT = antiprothrombin antibodies • aPL = antiphospholipid antibodies • aPTT = activated partial thromboplastin time • APLS = antiphospholipid syndrome • β2GPI = beta-2-Glycoprotein-1 • cAPLS = catastrophic antiphospholipid syndrome • CL = cardiolipin • dRVVT = diluted Russell's viper venom test • ELISA = enzyme linked immuno sorbent assay • LA = Lupus anticoagulant • PL = phospholipids • PL(–) = negatively charged phospholipids • PT = prothrombin • SLE = systemic lupus erythematodes

Key Words: Antiphospholipid syndrome • Heart valve • Cardiac surgery






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Copyright © 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.