Search

Aims Data on mitral annular disjunction (MAD) in children with Marfan syndrome (MFS) are sparse. To investigate the diagnostic yield of MAD by echocardiography and cardiac magnetic resonance imaging (CMR), its prevalence and progression during childhood. Methods and results We included patients <21 years old with MFS, defined by 2010 Ghent criteria and a pathogenic FBN1 variant or ectopia lentis. Two readers measured systolic separation between the mitral valve (MV) posterior hinge point and left ventricular (LV) myocardium on initial and subsequent imaging. MAD was defined as MV-LV separation ≥2 mm, MV prolapse (MVP) as atrial displacement ≥2 mm. Kappa coefficients evaluated echocardiogram–CMR agreement. Bland–Altman and intraclass correlation coefficients (ICCs) assessed inter-rater and inter-modality reliability. Univariable mixed-effects linear regression was used to evaluate longitudinal changes of MAD. MAD was detected in 60% (110/185) eligible patients. MVP was present in 48% (53/110) of MAD and MAD in 90% (53/59) of MVP. MAD detection by CMR and echocardiography had 96% overall agreement (Kappa = 0.89, P < 0.001) and a 0.32 mm estimate bias (95% CI 0.00, 0.65). ICC by echocardiography, CMR, and between modalities were 0.97 (95% CI 0.93, 0.98), 0.92 (95% CI 0.79, 0.97), and 0.91 (95% CI 0.85, 0.94), respectively. MAD was associated with aortic root dilation (P < 0.001). MAD was found in children of all ages, increased +0.18 mm/year (95% CI +0.14, +0.22) during a median duration of 5.5 years (IQR 3.1, 7.5 years). MAD indexed by height yielded a constant value +0.0002 mm/m/year (95% CI −0.0002, +0.0005 mm/m/year). Conclusion MAD was common in pediatric MFS and was associated with aortic root dilation. MAD detection by echocardiography and CMR was highly reliable, suggesting that routine assessment in MFS is feasible. MAD was present in neonates and progressed over time but remained constant when indexing by height. Further studies are needed to evaluate MAD as a biomarker for clinical outcomes in pediatric MFS. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) poses a significant clinical challenge, especially among patients with end-stage renal disease (ESRD) undergoing dialysis, and is associated with high morbidity and mortality rates. This review provides a contemporary discussion of the epidemiology, risk factors, diagnostic challenges, and management strategies for IE among ESRD patients, including a literature review of recent studies focused on this vulnerable population. The review highlights the multifactorial nature of IE risk in ESRD patients, emphasizing the roles of vascular access type, dialysis modality, and comorbid conditions. It also explores the diagnostic utility of different imaging modalities and the importance of a multidisciplinary approach in managing IE, including both medical and surgical interventions. The insights from this review aim to contribute to the improvement of patient outcomes through early recognition, appropriate antimicrobial therapy, and timely surgical intervention when necessary. [ABSTRACT FROM AUTHOR]

Objectives: Early meta-analyses comparing minimally invasive mitral valve surgery (MIMVS) with conventional sternotomy (CS) have determined the safety of MIMVS. We performed this review and meta-analysis based on studies from 2014 onwards to examine the differences in outcomes between MIMVS and CS. Specifically, some outcomes of interest included renal failure, new onset atrial fibrillation, mortality, stroke, reoperation for bleeding, blood transfusion and pulmonary infection. Methods: A systematic search was performed in six databases for studies comparing MIMVS with CS. Although the initial search identified 821 papers in total, nine studies were suitable for the final analysis. All studies included compared CS with MIMVS. The Mantel – Haenszel statistical method was chosen due the use of inverse variance and random effects. A meta-analysis was performed on the data. Results: MIMVS had significantly lower odds of renal failure (OR: 0.52; 95% CI 0.37 to 0.73, p < 0.001), new onset atrial fibrillation (OR: 0.78; 95% CI 0.67 to 0.90, p < 0.001), reduced prolonged intubation (OR: 0.50; 95% CI 0.29 to 0.87, p = 0.01) and reduced mortality (OR: 0.58; 95% CI 0.38 to 0.87, p < 0.01). MIMVS had shorter ICU stay (WMD: −0.42; 95% CI −0.59 to −0.24, p < 0.001) and shorter time to discharge (WMD: −2.79; 95% CI −3.86 to −1.71, p < 0.001). Conclusion: In the modern era, MIMVS for degenerative disease is associated with improved short-term outcomes when compared to the CS. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common sustained supraventricular arrhythmia encountered in clinical practice. Due to the higher prevalence of rheumatic fever in several regions of India, rheumatic heart disease (RHD) is the most common etiological factor of AF. Aims and Objectives: The objective of the study was to study clinical features, electrocardiographic (ECG) and echocardiographic (ECHO) findings, complications, and incidence of AF in rheumatic mitral valve disease (R-MVD). Methods: It is an observational cross-sectional study of 40 indoor patients in a Tertiary Care Hospital in Vadodara, Gujarat, carried over a period of a year. Clinical data including symptoms, signs, systemic examination, and relevant investigations were studied. Results: 67.5% (n = 27) of patients having AF were below the age of 50 years with higher incidence among females (72.50%) as compared to males (27.5%). Fifteen (37.5%) had mitral stenosis (MS) and 13 (32.5%) had MS with regurgitation. Most of the patients 35 (87.5%) presented with breathlessness, followed by palpitation 28 (70%). The most commonly heard murmur was mid-diastolic (65%, n = 26), followed by pansystolic murmur (40%, n = 16) at the apex. Out of 40 patients, 15 (37.5%) had evidence of left ventricular hypertrophy on ECG, whereas only 5 (12.5%) had right ventricular hypertrophy. Four out of five patients with the evidence of cardioembolic stroke had left atrium (LA) size >45 mm which suggests an increased risk of embolic stroke with increased LA size. Only 3 (7.5%) patients had a visible LA clot in LA on two-dimensional ECHO, whereas only one patient had vegetation on valves. Twenty-seven out of 30 patients treated with diltiazem show good response. Heart failure was the most common complication affecting 85% (n = 34) of the patients with AF with R-MVD. Four (10%) patients out of 40 expired including 1 (25%) of the four pregnant patients, suggesting higher mortality among pregnant females due to superimposed physiological changes occurring during pregnancy. Conclusion: In developing countries like India, RHD is a major cause of AF affecting the younger population and more commonly females. Most of the patients in our study presented with breathlessness and palpitation. LA size was directly proportional to the risk of cardioembolic stroke and most of the patients developed heart failure as a complication. [ABSTRACT FROM AUTHOR]

Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass' blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment. [ABSTRACT FROM AUTHOR]

Introduction: In the last decade, del Nido cardioplegia has been embedded in adult cardiac surgery involving CABG and aortic valve surgical procedures. We reviewed our early experience with del Nido cardioplegia in the setting of minimally invasive mitral valve surgery. Methods: Data on 120 consecutive patients operated between 03/2021 and 06/2022 were retrieved from our internal database (infective endocarditis and urgent operations were excluded). Patients were divided into two groups according to the use of Histidine-Tryptophan-Ketoglutarate or del Nido cardioplegia. A propensity match analysis was performed using thirteen preoperative and intraoperative variables. Several intraoperative data and early postoperative outcomes were investigated, including cardiac enzymes (Troponin I HS and CK-MB) measured upon arrival in the Intensive Care Unit (ICU), after 12 hours and everyday thereafter. Results: There was no difference in preoperative characteristics and surgical techniques between both unmatched and matched Histidine-Tryptophan-Ketoglutarate and del Nido populations. Patients in the del Nido group received a lower volume of cardioplegia (p < 0.001) and ultrafiltration during CPB (p < 0.001). Histidine-Tryptophan-Ketoglutarate was associated with a lower rate of post cross-clamp spontaneous defibrillation (p < 0.001) and showed a lower level of blood sodium after CPB (p < 0.001). The release of cardiac enzymes was similar between the two groups (p = 0.72). There was no difference in terms of postoperative morbidity and 30 day mortality. Conclusions: del Nido cardioplegia in the setting of minimally invasive mitral valve surgery seemed safe with acceptable myocardial protection and excellent early outcomes. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate if an increased frontal QRST angle (fQRSTa), an electrocardiographic derived index, can predict ventricular arrhythmias in dogs with myxomatous mitral valve disease, as well as to assess its role as a marker of disease progression. One hundred six dogs with myxomatous mitral valve disease and 20 control dogs underwent clinical and echocardiographic examination, along with 3-minute six-lead electrocardiographic recordings. The fQRSTa was calculated for each one of the 126 dogs. Differences between disease stages were investigated, along with possible correlations of the fQRSTa and other electrocardiographic variables associated with increased arrhythmogenesis. Interclass and intraclass correlation tests were applied to investigate repeatability. Finally, the sensitivity and specificity of fQRSTa in identifying arrhythmia predisposition and cardiac remodeling were calculated. An increase related to disease progression was documented for fQRSTa, with significant difference between groups C and B2 from control, and group C from B1. A fQRSTa >126.5 was able to discriminate B1 and control from B2 and C dogs with a sensitivity of over 79% and specificity of 60.66%. A fQRSTa >122.00 also discriminated the presence of arrhythmias from sustained sinus rhythms with a sensitivity of 88.24% and specificity of 70.00%. Finally, the index showed excellent repeatability, and positive correlations with previously reported ECG markers of arrhythmogenesis in dogs with myxomatous mitral valve disease. In conclusion, the fQRSTa is positively corelated to arrhythmogenesis and cardiac remodeling in dogs with myxomatous mitral valve disease. Dogs stages B2 and C show increased fQRSTa, which allows to infer that repolarization is affected as disease progresses. [ABSTRACT FROM AUTHOR]

Introduction: Persistent left superior vena cava (PLSVC) is one of the major sources of triggers and drivers of atrial fibrillation (AF). There has been no established PLSVC ablation procedure to eliminate the arrhythmogenicity along the entire length of PLSVC. Methods and Results: A 70‐year‐old woman with a history of two previous catheter ablations for AF, mitral valvuloplasty, and an unroofed coronary sinus‐type atrial septal defect closure underwent the redo AF ablations. The AF trigger and driver were identified within the patient's enlarged PLSVC. The AF was treated by complete PLSVC free wall isolation. Conclusion: Complete PLSVC free wall isolation may be an effective ablation method to eliminate the arrhythmogenicity along the entire length of the PLSVC. [ABSTRACT FROM AUTHOR]

Myxomatous mitral valve disease (MMVD) is a prevalent inherited mitral valve condition. This study aimed to evaluate the clinical manifestation of the cardiac condition MMVD in Poodles. Using ultrasonography (USG), this study examined the characteristics, progression, diagnosis, and treatment of MMVD in an 11-year-old Poodle. This case study was conducted at the Veterinary Teaching Hospital, School of Veterinary Medicine and Biomedical Sciences, utilizing a Chison Ebit60 with an 8–12 MHz curvilinear probe. The dog was positioned in the right parasternal recumbency position, and the long axis (RPLA) and short axis (RPSA) views were obtained. In the evaluation and diagnosis, B-Mode, M-Mode, and Color Flow Doppler (CFD) modes of ultrasonography were performed. The dog presented with coughing, and the physical examination revealed a grade 3–4 murmur. Based on B-mode cardiac monitoring, sinus arrhythmia, mitral valve thickness, and prolapses indicate MMVD. Mitral regurgitation was indicated by a decrease in heart rate and an increase in the left ventricle internal dimension (LVIDd) on the M-mode. Meanwhile, CFD's representation of turbulent flow confirmed mitral regurgitation results. The rise in blood pressure confirmed the presence of hypertension. Class B2 MMVD in Poodles has consequently been diagnosed in this case. [ABSTRACT FROM AUTHOR]

Mitral annular disjunction (MAD) is defined as a separation between the mitral annulus and the left ventricular myocardium and is most often seen in association with mitral valve prolapse (MVP). MAD has been linked to ventricular arrhythmias in adults, independent of MVP. However, it has rarely been reported in children. We, hereby, report two cases of MAD associated with a large atrial septal defect (ASD). Thus far, there are no consensus guidelines for the management of MAD. The additional association of large ASD further complicates the decision-making in these patients. To the best of our knowledge, this is the first report of the association of MAD with ASD. We further discuss the challenges in the management of this condition. [ABSTRACT FROM AUTHOR]

Background: Given the variety in mitral valve (MV) pathology and associated surgical techniques, extended reality (XR) holds great potential to assist MV surgeons. This review aims to systematically evaluate the currently available evidence investigating the use of XR and associated technologies in MV surgery. Methods: A systematic database search was conducted of original articles and case reports that explored the use of XR and MV surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to February 2022. Results: Our search yielded 171 articles, of which 15 studies were included in this review, featuring 328 patients. Two main areas of application were identified: (i) pre-operative planning and (ii) predicting post-operative outcomes. The articles reporting outcomes relating to pre-operative planning were further categorised as exploring themes relevant to (i) mitral annular assessment; (ii) training; (iii) evaluation of surgical technique; (iv) surgical approach or plan and (v) selecting ring size or type. Preoperatively, XR has been shown to evaluate mitral annular pathology more accurately than echocardiography, informing the surgeon about the optimal surgical technique, approach and plan for a particular patient's MV pathology. Furthermore, XR could simulate and aid ring size/type selection for MV annuloplasty, creating a personalized surgical plan. Additionally, XR could estimate the postoperative MV biomechanical and physiological characteristics, predicting and pre-empting post-operative complications. Conclusion: XR demonstrated promising applications for assisting MV surgery, enhancing outcomes and patient-centred care, nevertheless, there remain the need for randomized studies to ascertain its feasibility, safety, and validity in clinical practice. [ABSTRACT FROM AUTHOR]

Most individuals with ventricular septal defect survive to adulthood which allows time for other complications such as pulmonary arterial hypertension to gradually develop over a period of time. When there are other associated cardiac conditions that also contribute to the development of pulmonary hypertension such as valvular heart disease, the pulmonary hypertension may be exaggerated. Because these different etiologies of the pulmonary hypertension have different mechanisms, their coexistence can complicate patient management. We present a 26-year-old man with a large ventricular septal defect and rheumatic mitral valve disease who developed severe pulmonary hypertension that became complicated by atrial fibrillation and later sudden cardiac death. [ABSTRACT FROM AUTHOR]

Mitral valve replacement is a surgical procedure to replace a damaged or diseased mitral valve in the heart. There are different techniques for mitral valve replacement, including open-heart surgery and minimally invasive heart surgery. Here, we describe detailed steps of mitral valve replacement with a mechanical bileaflet valve which can be used by early career surgeons as a reference to perform safe cardiac surgery. [ABSTRACT FROM AUTHOR]

A 60-year-old housewife as admitted with fever, pain and redness in her right eye for 2 days. She had right eye redness with haziness of the cornea, white fibrinous material in the anterior chamber, and vitreous in the posterior segment. She was evaluated and found to have Endogenous Endophthalmitis (EE) with multiple cerebral infarcts due to methicillin-sensitive coagulase-negative Staphylococcus endocarditis. The patient received intravitreal injections of vancomycin and ceftazidime. She received cefazolin 2 g thrice daily intravenously. The plan of vitrectomy was suggested as per the advice from the ophthalmologist but the relatives opted for conservative management. The patient went into multiorgan failure with disseminated intravascular coagulation and despite all efforts, she succumbed to her illness. Our patient had two extracardiac manifestations of IE together. The presence of any of these manifestations should raise suspicion of infective endocarditis (IE). We report a case of native mitral valve methicillin-sensitive coagulase-negative Staphylococcus endocarditis presenting with extracardiac manifestations. Our case reminds readers to be aware of endocarditis when evaluating patients with extracardiac manifestations like EE. [ABSTRACT FROM AUTHOR]

The European Heart Journal—Cardiovascular Imaging with its over 10 years existence is an established leading multi-modality cardiovascular imaging journal. Pertinent publications including original research, how-to papers, reviews, consensus documents, and in our journal from 2022 have been highlighted in two reports. Part I focuses on cardiomyopathies, heart failure, valvular heart disease, and congenital heart disease and related emerging techniques and technologies. [ABSTRACT FROM AUTHOR]

The exponential rise in the incidence of peri‐mitral flutter has paralleled the increasing use of more extensive atrial substrate ablation for atrial fibrillation (AF). Given the relative paucity of randomized evidence to support its role in AF management, mitral isthmus ablation should largely be reserved for patients with peri‐mitral flutter. Catheter ablation for peri‐mitral flutter is challenging due to complex anatomic relationships. The aim of this report is to review the anatomic considerations and approaches to catheter ablation for peri‐mitral flutter. [ABSTRACT FROM AUTHOR]

Objective: Novel tissue leaflets (RESILIA tissue) may improve durability of bioprosthetic heart valves. The COMMENCE trial is an ongoing prospective study to evaluate valve replacement using RESILIA tissue. This report describes mid-term outcomes in the mitral cohort of COMMENCE. Methods: Adult patients requiring mitral valve replacement were enrolled in a prospective, single-arm trial at 17 sites in the United States and Canada. An independent clinical events committee adjudicated safety events using definitions from established guidelines, and hemodynamic performance was evaluated by an independent echocardiographic core laboratory. Results: Eighty-two patients (median age 70 years) successfully underwent mitral valve replacement with the study valve. Five-year event-free probabilities for all-cause mortality, structural valve deterioration, and reoperation were 79.9%, 98.7%, and 97.1%, respectively. Hemodynamic valve function measurements were stable through the 5-year follow-up period; valvular leaks were infrequently observed and primarily clinically insignificant/mild. Conclusions: Mitral valve replacement patients implanted with a RESILIA tissue bioprosthesis had a good safety profile and clinically stable hemodynamic performance.

Introduction: Vascular complications are a major issue in V-A ECMO and can affect long term outcome. Among these, Artero-Venous (AV) fistulas may lead to right heart failure. Case History: A 73-years patient supported with V-A ECMO for post-cardiotomy biventricular failure developed right heart failure after V-A ECMO decannulation, requiring V-A ECMO recannulation. The presence of an AV femoral fistula was incidentally revealed during femoral vein cannulation, from which oxygenated blood was unexpectedly drawn. The angiographic assessment confirmed the presence of a fistula between superficial femoral artery and vein, at the site of the first venous ECMO cannulation. This was caused by the venous cannula that inadvertently passed across the artery and created an AV fistula that was opened by the venous cannula removal. The exclusion of the endovascular fistula allowed the right heart failure resolution. Conclusions: In the presence of right heart failure after recent vascular manipulation, AV fistula should be ruled out. [ABSTRACT FROM AUTHOR]

Objective: To assess clinical characteristics and outcomes of women who underwent concurrent valve replacement with caesarean section for severe rheumatic mitral valve disease with refractory heart failure. Methods: All women admitted to a single centre from 2011 to 2020 with severe rheumatic mitral valve disease, having recurrent episodes of pulmonary edema on optimal medical therapy and contraindication to percutaneous balloon mitral valvotomy, who underwent concurrent valve replacement (for native valve disease) along with caesarean section, were included. Results: Among 1300 pregnancies with rheumatic heart disease, six underwent the concurrent procedure. All had replacement of mitral valve except one who had both aortic and mitral valve replacements, between 33 and 39 weeks of gestation. There were no maternal deaths, and there was one neonatal loss from late-onset sepsis. Conclusion: Pregnant women with severe rheumatic mitral valve disease with refractory heart failure, unsuitable for minimal access interventions, can be considered for a concurrent valve replacement with caesarean section. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy is a common genetic heart disease characterized predominantly by non-dilated hypertrophy of the left ventricle, in the absence of other cardiac, systemic, or metabolic diseases that can cause the observed degree of hypertrophy. The main features of left ventricular outflow tract obstruction include anatomical - basal septal hypertrophy in combination with a relatively small left ventricular cavity, leading to a change in the geometry of the outflow tract from the left ventricle, pushing the mitral valve apparatus forward, and functional - systolic anterior motion of elongated mitral valve leaflets with subsequent mitral-septal contact. Primary anatomical changes of the mitral valve make the valve more susceptible to abnormal flow vectors generated in the left ventricle cavity, creating the conditions for systolic anterior motion and mitral regurgitation. Septal myectomy, performed by experienced surgeons in specialized centers, eliminates obstruction at all levels of the left ventricular outflow tract, with a clinical success rate of 90-95% and a mortality rate of less than 1%. Some surgeons complement septal myectomy with intervention on the mitral valve, taking into account anatomical features when isolated septal myectomy may be ineffective. The choice of the most optimal concurrent intervention on the mitral valve during septal myectomy is undefined. Techniques for valve-sparing mitral valve surgery have been developed, including resection of secondary chords, edge-to-edge repair, anterior leaflet plication, and others. This review presents the hemodynamic outcomes of concomitant interventions on the mitral valve in addition to septal myectomy in patients with obstructive hypertrophic cardiomyopathy. [ABSTRACT FROM AUTHOR]

Background & Problems: Post-operation hypothermia tends to induce complications. Sixty percent of robotic-assisted mitral valve surgery patients experienced hypothermia while admitted to our intensive care unit (ICU), resulting in prolonged ICU stays and 57% (eight) of those patients with hypothermia also experiencing cardiac arrhythmia. The causes of hypothermia in our ICU included low temperature in the operating room, delayed initiation of blanket coverage after surgery, and lack of postoperative thermal blankets, insufficient cardiopulmonary bypass rewarming time, cold ICU beds, lack of in-service training for hypothermia, and lack of procedure auditing. Purpose: This intervention was designed to reduce the incidence of hypothermia in ICU patients undergoing robotic-assisted mitral valve surgery upon ICU admission from 60% to 36% and the one-hour hypothermia rate from 43.3% to 26%. Resolutions: We implemented several measures including increasing the room temperature, pre-heating the ICU bed, achieving team consensus regarding prolonging the rewarming time after cardiopulmonary bypass, establishing a blanket warming area for postoperative patient use, and holding in-service training to enhance the awareness of the nurses were implemented. Result: The incidence of hypothermia in ICU patients receiving robotic-assisted mitral valve surgery upon ICU admission decreased from 60% to 19.4%, while the one-hour hypothermia rate decreased from 43.3% to 19.4%. Conclusions: Using systemic interprofessional collaboration, combined thermal care can be achieved to significantly reduce the incidence of postoperative hypothermia in patients undergoing robotic-assisted mitral valve surgeries resulting in higher patient care quality and shorter ICU stays. We recommend applying this combined method to improve the quality of perioperative care for long-duration and major surgical procedures that involve large postoperative wounds and for patients who may require wider exposure during their operation. [ABSTRACT FROM AUTHOR]

An incomplete right bundle branch block (RBBB) associated with coagulation disturbance in mitral valvular disease was diagnosed in a five-year-old female Dachshund. Morphologically moderate mitral valvular thickening and nodularity could be noticed on echocardiography. Prolonged activated partial thromboplastin time and thrombocytopaenia supported the probable underlying mechanism for myocardial infarction and RBBB. The animal showed clinical improvement after one month of therapy with enalapril and torasemide for mitral valve insufficiency. [ABSTRACT FROM AUTHOR]

Background: For severe mitral valve (MV) degenerative disease, repair is recommended. Prediction of repair complexity and referral to high volume centers can increase rates of successful repair. This study sought to demonstrate that TEE is a feasible imaging modality to predict the complexity of surgical MV repair. Methods: Two hundred TEE examinations of patients who underwent MV repair (2009–2011) were retrospectively reviewed and scored by two cardiac anesthesiologists. TEE scores were compared to surgical complexity scores, which were previously assigned based on published methods. Kappa values were reported for the agreement of TEE and surgical scores. McNemar's tests were used to test the homogeneity of the marginal probabilities of different scoring categories. Results: TEE scores were slightly lower (2[1,3]) than surgical scores (3[1,4]). The agreement was 66% between the scoring methods, with a moderate kappa (.46). Using surgical scores as the gold standard, 70%, 71%, and 46% of simple, intermediate and complex surgical scores, respectively, were correctly scored by TEE. P1, P2, P3, and A2 prolapse were easiest to identify with TEE and had the highest agreement with surgical scoring (P1 agreement 79% with kappa.55, P2 96% [kappa.8], P3 77% [kappa.51], A2 88% [kappa.6]). The lowest agreement between the two scores occurred with A1 prolapse (kappa.05) and posteromedial commissure prolapse (kappa.14). In the presence of significant disagreement, TEE scores were more likely to be of higher complexity than surgical. McNemar's test was significant for prolapse of P1 (p =.005), A1 (p =.025), A2 (p =.041), and the posteromedial commissure (p <.0001). Conclusion: TEE‐based scoring is feasible for prediction of the complexity of MV surgical repair, thus allowing for preoperative stratification. [ABSTRACT FROM AUTHOR]

Atrial premature contractions (PACs) that block at the atrio‐ventricular (AV) nodal level and occurring in a bigeminal frequency are recognized as a cause of symptomatic bradycardia. Appropriate suppression of the PACs often results in restoration of a regular rhythm with resolution of bradycardia‐related symptoms. We report a series of three patients with non‐conducted bigeminal PACs arising from the mitral annulus that resulted in symptomatic bradycardia and who were referred for consideration of cardiac pacing. Focal ablation suppressed PACs restoring a normal heart rate and resolution of symptoms without resorting to cardiac pacing. [ABSTRACT FROM AUTHOR]

Available data have demonstrated important sex-related differences in patients with valvular heart disease, regarding clinical presentation, treatment, and outcomes. Although the calcific aortic stenosis (AS) is more frequent in men compared to women, the majority of AS patients over 80 years old are women, in whom fibrotic remodeling of aortic valve is typically found. Mitral valve disease is more common in women. However females are under-referred or delayed referrals to treatment, probably due to the absence of sex-based LV dimension values guiding surgical timing. The development of transcatheter devices have revolutionized the treatment of valvular heart disease and increased the interest in this topic. In this context, the consideration of gender differences in presentation, diagnosis, treatment success, and prognosis is of great importance. [ABSTRACT FROM AUTHOR]

The article focuses on potential afterload mismatch and the impact of pharmacologic support after MitraClip implantation a transcatheter therapy for mitral regurgitation. Topics include the definition and causes of afterload mismatch, the potential complications and risks associated with it, and the role of pharmacologic support in mitigating these risks.

Reports on degenerative mitral valve disease in dogs in Malaysia are limited. This retrospective cohort study investigated the association between gender, age group, and breed size with respect to the risk of degenerative mitral valve disease. The median survival time of the dogs in stages B2, C, and D and levels of owners' compliance were also estimated. Canine case records at University Veterinary Hospital, University Putra Malaysia from July 2013 to July 2021 were reviewed. Owners were contacted to ascertain their compliance with the treatments and the current status (deceased/alive) of their pet dog. The risk factors were analyzed through a logistic regression model and median survival time was determined through the Kaplan-Meier estimator curve. In this study, 306 out of 753 (40.6%) dogs with heart disease had degenerative mitral valve disease. Following an adjustment to the age group, small breed size was the only significant risk factor (p < .001). Dogs in B2 had the longest median survival time (p < .001), while compliance to treatment was associated with longer median survival time in dogs in Stages C (p = .015) and D (p = .001). The findings of this study may help in motivating owners to pursue long-term treatment and management of dogs with degenerative mitral valve disease. [ABSTRACT FROM AUTHOR]

We report a rare congenital heart disease characterized by multiple ventricular septal defects associated to anomalous systemic and pulmonary venous returns, marked apical myocardial hypertrophy of both ventricles and of right outflow, and hypoplastic mitral anulus. Multimodality imaging is mandatory to assess anatomical details. [ABSTRACT FROM AUTHOR]

The present study was carried out with the objective of evaluating the response to a combination therapy of enalapril and torasemide in dogs with mitral valve disease (MVD). Dogs diagnosed with stage C of MVD as per the American College of Veterinary Internal Medicine guidelines were included in the study. Treatment was initiated with enalapril at 0.5 mg/kg BID and torasemide at 0.2 mg/kg OD orally on 0th day. Detailed clinical examination with special reference to the cardiovascular system including measurement of blood pressure, radiographic, electrocardiographic and echocardiographic parameters of the animals were performed on 0th and 30th day of treatment. The treatment was well tolerated by all the animals. Amelioration of clinical signs with a noticeable reduction in cough was noticed in all the animals. On 30th day of treatment, a significant decrease was noticed in the vertebral heart score and left ventricular internal diameter during diastole and a non-significant decrease was noticed in left atrium to aortic root ratio, left ventricular internal diameter during systole, with a considerable reduction in severity of mitral regurgitation. Post-treatment clearing of lung fields was noticed in dogs with radiographic evidence of pulmonary oedema on 0th day. In addition to this, ventricular premature complexes noticed in three animals pre-treatment was not noticed post treatment. [ABSTRACT FROM AUTHOR]

A 60‐year‐old patient, professor of physics, presented in 1999 with sudden‐onset vitiligo associated with hyperprolactinemia and a prolactinoma. Fearful of potential surgical complications at the peak of his career, the patient declined surgery and opted for medical management with bromocriptine. The decreasing effectiveness of bromocriptine after 5 years required a switch to cabergoline. After a 15‐year‐course of cabergoline therapy with a cumulative dose of 572 mg, echocardiographic monitoring demonstrated aortic and mitral valve thickening and regurgitation. An additional 3 years of cabergoline treatment (cumulative dose: 649 mg) resulted in worsening valve thickening and regurgitation. It is well‐recognized that such valvular changes may occur with high‐dose cabergoline treatment. We report a case of mitral and aortic vavulopathy in a patient who was treated with long‐term (18 years) low‐dosage (.5–1 mg weekly) cabergoline. cabergoline, echocardiography, valvulopathy [ABSTRACT FROM AUTHOR]

Introduction: The necessity of complete bi‐atrial lesion created by radiofrequency clamp and pen for nonparoxysmal atrial fibrillation (AF) in patients with rheumatic mitral valve disease (RMVD) remains unclear. Methods: From January 2014 to December 2018, patients with RMVD concomitant with nonparoxysmal AF who underwent mitral valve surgery concomitant surgical ablation were retrospectively enrolled. We divided patients into Group A (complete bi‐atrial lesion set created by radiofrequency clamp and pen) and Group B (simplified lesion sets created by radiofrequency clamp alone including bi‐atrial ablation with incomplete mitral isthmus line and stand‐alone left atrial ablation) according to the surgical ablation lesion sets. Propensity score matching was applied to analyze freedom from atrial tachyarrhythmias between the two groups. Results: Two hundred eight (38.5%) and 332 (61.5%) patients were divided into Group A and Group B, respectively. In Group B, the proportion of patients with recurrent atrial flutter in the subgroup of bi‐atrial ablation with incomplete mitral isthmus line was higher than that in Group A (p =.044). After propensity score matching, there were 203 patients in each group. Better freedom from atrial tachyarrhythmias without antiarrhythmic drugs was obtained in Group A (83.1%, 79.6%, and 65.4%) than Group B (73.1%, 68.4%, and 52.7%) at 12, 36, and 60 months after operation (p =.012). Conclusion: The application of radiofrequency clamp and pen to create complete bi‐atrial lesion set in surgical ablation for nonparoxysmal AF in RMVD was associated with superior long‐term efficacy. [ABSTRACT FROM AUTHOR]

Background: Canine hypercortisolism (HC) is the most prevalent endocrinopathy in dogs in southern Brazil. The prognosis depends on several factors including the general health status, owners' commitment, and the development of disease complications and comorbidities occurrence, such as cardiovascular complications including mitral valve disease (MVD), systemic arterial hypertension, and left ventricular hypertrophy. The main objective of the present study was to assess cardiovascular parameters in canine HC, based on investigating survival-related variables. The study also aimed to evaluate the influence of concurrent preclinical (MVD) on dogs' survival and the impact of HC on MVD progression. Materials, Methods & Results: A total of 25 dogs with spontaneous HC were enrolled and divided into 2 subgroups accordingly to their echocardiographic findings: group HC (normal echocardiography at first evaluation, n = 16); and group HC + MVD (concurrent presence of stages B1 and B2 MVD diagnosed at the first evaluation, n = 9). The patients were evaluated at diagnosis (T0); 6 months after treatment begging (T1); and after 12 months of treatment (T2). The owners were further contacted by phone or e-mail for 1 more year after T2 regarding survival information. A control group (CG, n = 20) was also evaluated at T0 and T1. At each evaluation, dogs were submitted to a complete clinical evaluation and physical exam, associated with a minimum database (CBC, serum biochemistry, and urine analysis) and cardiovascular evaluation composed of systolic blood pressure determination, electrocardiogram (ECG), and echodopplercardiography. In the HC group, 11/16 dogs underwent the evaluation at T2, while 4/9 dogs from the HC + MVD group and 17/20 dogs from the CG underwent the evaluation at T2. Five dogs (31.25%) from the HC group and 4 dogs (44.44%) from the HC + MVD group died before the end of the follow-up period. In the control group, only 1 dog (5.26%) died before the end of the study. Despite the higher mortality in the HC + MVD group during the follow-up period, there was no significant difference (P = 0.632) in survival when compared with the HC group. The MVD of 4 dogs included in the HC + MVD group was classified as stage B1, while the other 5 dogs were classified as stage B2. Only 1 dog from the CG developed stage B1 MVD in the period studied; however, progression of the MVD stage was documented in 1/4 of dogs in the HC + MVD group and MVD development was documented in 3/11 of dogs from the HC group from T0 to T2. The odds ratio (OR) and respective 95% confidence interval (95%CI) for HC as a risk factor for MVD progression were 4.267 (0.4268 - 42.65; P = 0.342). Exercise intolerance (12/16 dogs) and dyspnea (6/16 dogs) were the cardiorespiratory clinical signs with the highest incidence in the HC group at T0. When compared to the control group, both exercise intolerance (P < 0.001) and dyspnea (P = 0.03) occurrence were significantly higher in the HC group. The age (P = 0.001) and the occurrence of dyspnea (P = 0.036) at diagnosis were significantly higher in dogs with HC that died during the follow-up than those that remained alive. Regarding the occurrence of cardiac arrhythmias verified by ECG, no statistically significant differences were observed among groups. Discussion: The study suggests that systemic hypertension and altered echocardiographic measurements did not interfere with dogs' survival; however, dyspnea was associated with a worse prognosis. Finally, it is possible to conclude that mitral valve degeneration is a common comorbidity in dogs with HC, however, it was not evidenced their interference in the survival of dogs with this endocrine disease or even a role of the HC in the progression of the MVD. [ABSTRACT FROM AUTHOR]

Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri- operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC. [ABSTRACT FROM AUTHOR]

Background: As early as the era of cardiopulmonary bypass, Median Sternotomy was used to execute mitral valve surgeries. Minimally invasive mitral valve surgery (MVS) through right mini-thoracotomy has lately received a great deal of interest. The major aim of this study was to evaluate clinical outcome of anterior thoracotomy compared to traditional median sternotomy for mitral valve replacement. Methods: 146 subjects with mitral valve disease (moderate to severe) scheduled to undergo elective mitral valve replacement were separated into two groups: group I through conventional median sternotomy and group II through anterior thoracotomy. Results: A statistically significant difference was found in cross-clamp time between the two groups. Crossclamp time was higher in group II (67.2 ± 5.6 minutes) than group I (46.05 ± 4.7 minutes). Total bypass time was higher in group II (86.2 ± 5.7 hours) than group I (75.5 ± 5.1 hours). Also, total operating time was higher in group II (276.2 ± 5.6 minutes) than group I (238.1 ± 5.6 minutes). A significant discrepancy was found between VAS scores in the two groups in the 1st and 2nd day and time to return to normal activity that were higher in group I than group II. Hypertrophic scar was found in 21 patients (28.7%) of group I and 7 patients (9.5%) in group II with statistically significant difference. 24 patients in group I (32.8 percent) and 68 patients in group II (93.1 percent) were happy with the look and aesthetic quality of their scars. Conclusions: Mitral valve replacement through minimally invasive right anterolateral thoracotomy has a longer cross-clamp duration, total bypass time, and total operating time than the standard median sternotomy, but it is a viable option. It results in less bleeding, less discomfort, a shorter hospital and ICU stay, and a quicker recovery. [ABSTRACT FROM AUTHOR]

Background: Percutaneous balloon mitral valvuloplasty (PBMV) is considered the most suitable option for managing symptomatic severe mitral valve stenosis (MS) during pregnancy with favorable anatomy. We do not know the best time to perform PBMV during pregnancy to achieve the best maternal and fetal outcomes. Therefore, we conducted this study to clarify the best procedure timing. Methods: This prospective, observational, single-center study involved 44 pregnant patients suffering from symptomatic MS who underwent PBMV from May 2017 to May 2020. A detailed history is taken, full clinical examination, laboratory assessment, 2 D echocardiography, and follow-up during the hospital stay and monthly until labor. Results: We found that the mean mitral valve area (MVA) had significantly increased from 1.12 ± 0.24 to 2.09 ± 0.46 cm2 (P < 0.001). The mean pressure gradient across the mitral valve reduced from 17.22 ± 5.55 to 8.94 ± 3.75 mmHg (P < 0.001). The procedures were successful in 91% of the patients. Regarding obstetric outcomes, the incidence of preterm labor, fetal death, and composite adverse outcomes was significantly lower in patients who had the procedure during the second trimester than those who had the procedure during the third trimester. All preterm deliveries and intrauterine fetal deaths occurred at least 21 days after PBMV. The patients showed a statistically significant improvement in NYHA functional classification. Conclusion: We can conclude that PBMV performed in pregnant patients is an effective and safe treatment modality, and we observed better obstetric outcomes achieved with early intervention during the second trimester. [ABSTRACT FROM AUTHOR]

Background: Lack of scientific data on the feasibility and safety of minimally invasive cardiac surgery (MICS) during the COVID-19 pandemic has made clinical decision making challenging. This survey aimed to appraise MICS activity in UK cardiac units and establish a consensus amongst front-line MICS surgeons regarding standard best MICS practise during the pandemic. Methods: An online questionnaire was designed through the 'googleforms' platform. Responses were received from 24 out of 28 surgeons approached (85.7%), across 17 cardiac units. Results: There was a strong consensus against a higher risk of conversion from minimally invasive to full sternotomy (92%; n = 22) nor there is increased infection (79%; n = 19) or bleeding (96%; n = 23) with MICS compared to full sternotomy during the pandemic. The majority of respondents (67%; n = 16) felt that it was safe to perform MICS during COVID-19, and that it should not be halted (71%; n = 17). London cardiac units experienced a decrease in MICS (60%; n = 6), whereas non-London units saw no reduction. All London MICS surgeons wore an FP3 mask compared to 62% (n = 8) of non-London MICS surgeons, 23% (n = 3) of which only wore a surgical mask. London MICS surgeons felt that routine double gloving should be done (60%; n = 6) whereas non-London MICS surgeons held a strong consensus that it should not (92%; n = 12). Conclusion: Whilst more robust evidence on the effect of COVID-19 on MICS is awaited, this survey provides interesting insights for clinical decision-making regarding MICS and aids to facilitate the development of standardised MICS guidelines for an effective response during future pandemics. [ABSTRACT FROM AUTHOR]

Calcium deposition in the heart can present in various ways. Mitral annular calcification (MAC) can cause mitral regurgitation but severe mitral stenosis has been reported very rarely. Mitral stenosis in the Indian subcontinent is mostly caused by rheumatic heart disease; however, here, we present a case of severe mitral stenosis due to MAC in a hypertensive and diabetic female that also had severe calcific aortic stenosis and conduction defect. Clinicians need to be aware of other causes of acquired mitral stenosis that include systemic lupus erythematosus, antiphospholipid antibody syndrome, carcinoid syndrome, mucopolysaccharidosis, Whipple disease, radiation, and MAC. Although MAC usually causes mitral regurgitation, severe mitral stenosis has been reported very rarely. However, when MAC is the cause of severe mitral stenosis, those patients are poor candidates for mitral valve replacement. Differentiating the etiology of mitral stenosis is of therapeutic and prognostic significance. [ABSTRACT FROM AUTHOR]

Background: Mitral Valve (MV) disease is responsible for a considerable number of open cardiac surgeries. Selecting a befitting prosthetic valve is a matter of consideration. Thus, accurate definition of mitral apparatus characteristics, particularly mitral annulus dimensions, preoperatively can shed some light on the situation. The less invasive nature of three-dimensional Transesophageal Echocardiography (3D-TEE) can turn it into a practical modality for preoperative investigation of mitral anatomy. Objectives: The present study aimed to investigate the correlation between the size of mitral annulus attained through 3D-TEE and intraoperative size as well as the valve or ring size finally placed in mitral position. Methods: The study was conducted on 28 patients suffering from MV disease who were candidates for MV surgery. All the patients underwent 3D-TEE. Mitral annulus diameters including anteroposterior and intercommissural diameters were measured delicately by using the Mitral Valve Navigation (MVN) tool. In the midst of surgery, a mitral ring sizer was utilized in order to suggest the proper prosthesis size. Results: The study results demonstrated that the sizer instrument was strongly associated with the inserted prosthesis size and moderately with echocardiographic annulus diameters. The correlation between the deployed prosthesis size and annulus size obtained by intraoperative sizer and 3D echocardiography was assessed, as well. The results indicated that ring sizer showed a strong positive relationship with the intercommissural echocardiography diameter and a moderate positive relationship with the anteroposterior echocardiography diameter. Conclusion: The results revealed a good correlation between the echocardiography measurements and intraoperative examination along with the deployed prosthesis size. Thus, 3D-TEE could be considered a practical modality for the preoperative investigation of mitral anatomy. [ABSTRACT FROM AUTHOR]

Auscultation methods enable non-invasive diagnosis of diseases, e.g. of the heart, based on heartbeat sounds. Regular, early examinations using machine learning techniques could help to detect diseases at an early stage to prevent serious health conditions and then provide optimal therapy through continuous monitoring. There is already a lot of work on human data using AI algorithms to detect patterns in signals or images. However, there is hardly no work on detecting heart murmurs with digital such as Myxomatous Mitral Valve Disease. In this paper, we present a canine auscultation project that aims to provide a tool to establish a baseline of classification parameters from audio signals that could be used to monitor canine health status by analyzing deviations from this baseline. In the future, data analysis could also lead to prediction and early detection of other diseases. [ABSTRACT FROM AUTHOR]

Introduction: Infective Endocarditis (IE) is an uncommon condition with a poor prognosis, high morbidity and mortality, with an incidence of approximately 5 per 100, 000, per year. It usually presents in elderly patients with multiple comorbidities, in young patients via an oral infective route, or intravenous drug users. Given the increasing complexity of diagnosis and management, a multidisciplinary approach is recommended in specialty literature. Antibiotic therapy and surgery remain the mainstays of treatment. Case Report: We present the case of a 24 year old female patient - a university student with no significant past medical history, minor dental work 4 months prior to presentation, allergic to Penicillin and Streptomycin, admitted to the Royal Hampshire County Hospital following 5 days of fever, abdominal pain, nausea, headache and loss of appetite, as well as painful peripheral lesions. On admission, she was found to be septic, with raised inflammatory markers. Janeway lesions, splinter haemorrhages and Osler nodes were noted, with unremarkable cardiovascular examination. In light of the presentation and allergies, she was initially started on broad spectrum antibiotics to cover for IE. This was later revised with the sensitivity data. Staphylococcus Aureus was found on blood cultures. On Transthoracic Echocardiogram (TTE) no convincing evidence of vegetation was found. Given the history and presentation and the normal findings on TTE, the initial impression was of a vasculitis. However, a Transoesophageal Echocardiogram (TOE) showed a large mitral vegetation extending into the left chambers, with a perforated P3 and severe regurgitation. She was transferred for urgent Mitral Valve replacement, which was completed without complications. Lifelong anticoagulation was started, along with a 6-week course of antibiotics. She had been recovering well when seen 2 months post-operatively. Discussions : The evolution of epidemiology and presentation of IE, along with updated methods of diagnosis and treatment has led to increasing complexity in the management of these types of patients. Our patient is young and otherwise healthy and was therefore able to compensate well for a prolonged time before the acute septic presentation with a level of vegetation requiring surgical intervention. Conclusions: IE is a severe condition that may present non-specifically in young otherwise healthy individuals. A multidisciplinary approach is important, with involvement from Cardiology, Infectious Diseases, and Cardiothoracic Surgery. A consideration should be made as to the accuracy of TTE vs TOE findings in the context of presentation, blood cultures and response to treatment. [ABSTRACT FROM AUTHOR]

Background: Accessory mitral valve tissue (AMVT) is an extremely rare causes left ventricular outflow tract (LVOT) obstruction and is usually incidentally detected in childhood. It is often associated with other cardiac and vascular congenital malformations. Case Presentation: In this case, we present a 15‐year‐old girl was diagnosed with AMVT by transesophageal echocardiography, resulting in LVOT obstruction during systole. Interestingly enough, the patient's accessory mitral valve remained undetected for years until he became symptomatic for wide ASD. Successful closure of the ASD with resection of the AMVT was performed with a transaortic approach. The patient was hemodynamically stable postoperatively. There were no abnormalities in the mitral valves and LVOT. Conclusion: It was also unusual to see AMVT with ASD instead of other frequently associated other congenital anomalies. Accessory mitral valve should be considered a rare but important cause of left ventricular outflow tract obstruction in childhood. [ABSTRACT FROM AUTHOR]

Background: Atrioventricular groove disruption (AVGD) is a rare and severe complication of mitral valve surgery (MVS). Current literature is limited to several case reports and series. Our aim was to analyze outcomes of patients with AVGD after MVS from our tertiary cardiac surgery center. Methods: Between June 2010 and January 2019, 18 patients suffering AVGD were identified in our institutional database and included in our retrospective observation. Preoperative, intraoperative and outcome data were analyzed using IBM SPSS Statistics. Late survival was estimated by using the Kaplan–Meier survival analysis. Results: The mean age of the study population was 76 ± 5 years. Most common indication for MVS was an isolated mitral valve insufficiency (67%). Severe annular calcification was present in four patients (22%). Majority of implanted valves were biological prosthesis (78%). Due to the location, 72% suffered type I rupture. External repair was performed in 94% of all patients. Second look operation in regard of excessive mediastinal hemorrhage was necessary in 67% of patients. Mean hospital stay of the presented collective was 13 ± 11 days with an intra-hospital mortality of 56%. Late follow-up was obtained in eight patients at an average of 3.1 (1.6–5.7) years postoperatively. Conclusion: Mortality rates for AVGD after MVS are high. However, way of managing AVGD depends on the underlying type of rupture and should be evaluated in regard of the myocardial damage. Due to the rare occurrence, registry data might help to address more scientific value concerning therapeutic measures and outcomes of this severe complication. [ABSTRACT FROM AUTHOR]

We report a rare case of dense mitral annular calcification in a 26-year-old male presenting with recurrent palpitation for the last year with a plethora of mitral annular premature ventricular complexes (PVCs). PVCs had right bundle branch block morphology, were notched in inferior leads with negative QRS complexes in aVL suggestive of likely origin from the lateral mitral annulus. Patients with PVCs from mitral annulus are usually advised to undergo cardiac magnetic resonance imaging to localize the site of subtle mitral annular calcification and plan subsequent delivery of radiofrequency lesions at the same site during radiofrequency ablation. Dense calcification of the lateral mitral annulus is extremely rare to encounter in such a young age of below 30 years without the presence of any predisposing risk factors for calcification. Our case is the first illustration of dense mitral annular calcification secondary to the plethora of mitral annular PVCs in a symptomatic young person below the age of 30 years. PVCs-induced excessive local excursion with wear and tear phenomenon and secondary dystrophic calcification may be the plausible explanation behind this interesting presentation. [ABSTRACT FROM AUTHOR]

Background: The current literature focuses on the risk of infective endocarditis (IE) following transcatheter aortic valve implantation (TAVI). However, the risk of IE in patients waiting for TAVI is not well-studied. We present a unique case of a patient waiting for TAVI with decompensated heart failure who was found to have a large mitral vegetation, and consider risk factors for the development of IE in this population. Case description: We report the case of an 85-year-old male with severe aortic stenosis and recurrent small bowel angiodysplasias, requiring frequent blood transfusions and intravenous iron. He presented to a peripheral hospital in decompensated heart failure. Transfer was arranged to our center to expedite TAVI, under the premise that worsening aortic stenosis precipitated his decompensated state. Prior to TAVI, an echocardiogram was done, and demonstrated a 30 × 18 mm mass on the mitral valve with anterior leaflet perforation and severe mitral regurgitation. The findings were consistent with IE, and the TAVI was cancelled. Despite antibiotic therapy, the patient unfortunately deteriorated and palliative care was provided. Conclusions: This case highlights the need for further research regarding the risk of IE in patients waiting for TAVI. Current literature focuses on the development and management of IE following TAVI. Clinicians must understand that TAVI candidates have multiple risk factors for IE, including valvular disease, age, and comorbidities. IE should be considered as a possible cause for decompensated heart failure in patients awaiting TAVI. [ABSTRACT FROM AUTHOR]

Teaching Point: Caseous calcification of the mitral annulus is a benign mass-like lesion which can mimic cardiac tumor or abscess; therefore, multimodal imaging should be considered, avoiding unnecessary interventions. [ABSTRACT FROM AUTHOR]