NOTE: The criteria are not always easy to follow.
NOTE: A patient who meets the clinical criteria (vascular thromboses and/or pregnancy morbidity) for the antiphospholipid syndrome is excluded from the definition.
Patient examination may include:
(1) The valvular examination may be performed by echocardiography (trans-thoracic or transesophageal).
(2) Quantifying valvular dysfunction should be performed with Doppler ultrasonography.
(3) Histopathologic examination may be performed if the valves are repaired or replaced.
Features:
(1) laboratory features of the antiphospholipid syndrome, with the presence of:
(1a) lupus anticoagulant
(1b) anticardiolipin antibody
(1c) anti-beta-glycoprotein I antibody
(1d) mixture of 2 or more types
(2) presence of one or more of the following:
(2a) presence of valve thickening
(2b) presence of irregular nodules or vegetations
(2c) presence of valve dysfunction (any combination of moderate to severe mitral regurgitation, mitral stenosis, aortic regurgitation, aortic stenosis)
(3) exclusion another explanation for the valve disease including:
(3a) rheumatic fever or rheumatic heart disease
(3b) infective endocarditis
Features of valve lesions - thickening:
(1) thickening of the valve, with thickness > 3 mm
(2) localized thickening in the proximal or middle portion
Features of valve lesions - vegetations
(1) irregular nodules or vegetation on the edge of the mitral valve along the atrial face
(2) irregular nodules or vegetations along the vascular face of the aortic valve
where:
• Mild mitral regurgitation is common in the general population and so is not used.
• No mention of the tricuspid or pulmonic valve is made.
