Mitral annular calcification (MAC) is a chronic degenerative process strongly associated with aging that predominantly affects the posterior mitral annulus. Its pathogenesis is linked to traditional cardiovascular risk factors that increase mechanical stress and inflammation, promoting pathological cellular differentiation within the annulus. MAC prevalence in the general population is approximately 8-15%, with 8% of affected patients developing clinically significant valvular disease, defined as mitral stenosis or moderate or greater mitral regurgitation. Patients with MAC are at higher risk of cardiovascular mortality and complications, including the development of atrial fibrillation, the development of conduction disorders, and often have signs of coronary or systemic atherosclerosis. Transthoracic echocardiogram remains the first-line imaging modality for the diagnosis of MAC, while cardiac-gated computed tomography is valuable for quantifying severity and progression while also guiding procedural planning. Though management is often conservative, in patients who have clinically significant valvular dysfunction, MAC can present a challenge when planning valvular interventions, and a multidisciplinary approach is often required.

Libman-Sacks endocarditis (LSE), characterized by sterile valvular vegetations, is a recognized complication of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). However, its occurrence as the initial manifestation of previously undiagnosed autoimmune disease is uncommon and may create significant diagnostic uncertainty. A 27-year-old female presented to the emergency department with acute-onset exertional dyspnea, cough, and severe anemia, with a history of three consecutive first-trimester miscarriages. Initial evaluation revealed severe mitral regurgitation with valvular masses, raising suspicion for infective endocarditis. Further workup demonstrated elevated inflammatory markers, autoimmune hemolytic anemia, nephrotic-range proteinuria, and positive autoimmune serology, including antinuclear antibodies, anti-double-stranded DNA, anticardiolipin IgG, anti-β2-glycoprotein I IgG, and lupus anticoagulant. Transthoracic echocardiography showed severe mitral regurgitation with valvular masses and reduced left ventricular ejection fraction, while transesophageal echocardiography confirmed Libman-Sacks vegetations. Computed tomography of the chest revealed diffuse alveolar hemorrhage. The patient was diagnosed with new-onset SLE and APS, presenting with LSE and multisystem involvement. Management included pulse methylprednisolone therapy, hydroxychloroquine, cyclophosphamide, therapeutic anticoagulation, and plasma exchange for alveolar hemorrhage, resulting in clinical improvement with resolution of hemoptysis and improvement in cardiac function. This case is particularly notable because severe valvular disease led to the initial recognition of previously undiagnosed SLE and APS in the setting of simultaneous pulmonary, hematologic, renal, and obstetric manifestations. It highlights the importance of considering autoimmune etiologies in young patients with unexplained valvular heart disease, particularly in the presence of suggestive systemic features.

•Transcatheter edge-to-edge repair (TEER) has now become the standard treatment option for patients with moderate to severe or severe symptomatic functional mitral regurgitation (MR) despite the guideline-directed medical therapy.•The MitraClip (Abbott Vascular, Santa Clara, California) is the only TEER system currently approved by the Food and Drug Administration for the treatment of functional MR.•This study has demonstrated the initial safety and efficacy of a new TEER device (Clip2Edge system, IasoCardiac Medical Technology Co, Ltd, Shanghai, China) for treating functional MR patients who remain symptomatic despite guideline-directed medical therapy.•This device may provide an additional treatment option for this patient population.

Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition that follows SARS-CoV-2 infection, characterized by persistent fever and multi-organ dysfunction. Cardiac involvement occurs in 67%-80% of cases, representing a critical clinical concern. Data from tropical and Caribbean regions remain limited in the global MIS-C literature. We conducted a cross-sectional study with retrospective data collection at Hospital Infantil Napoleón Franco Pareja, Colombia. Included patients were <18 years with a MIS-C diagnosis per WHO/CDC/RCPCH criteria and positive SARS-CoV-2 serology. Cardiac involvement was defined by elevated troponin, abnormal echocardiography, or electrocardiogram changes. Among n = 105 patients (median age 5 years, 61% male), cardiac involvement occurred in 25.7% (n = 27). The median number of affected organ systems was 4 (IQR: 3-4). Coronary artery dilation was the predominant cardiac finding (37.0% of cardiac cases), followed by mitral regurgitation and elevated troponin (both 33.3%). No patients showed left ventricular ejection fraction <55%. Treatment included corticosteroids (92.4%), acetylsalicylic acid (91.4%), and immunoglobulin (70.5%). All patients survived to discharge (100% survival). One-month follow-up revealed persistent coronary dilation in 2.9%. MIS-C affects multiple organ systems with coronary artery dilation as the predominant cardiac manifestation in our population. Favorable acute outcomes were observed with the current management protocols, including 100% survival and brief hospitalizations. However, persistent cardiac abnormalities in a subset of patients emphasize the need for systematic cardiac surveillance. These findings from a tropical Caribbean population provide insights applicable to resource-limited settings in other low- and middle-income countries.

Pulmonary endarterectomy (PEA) is a potentially curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH); however, decompensated right heart failure and concomitant cardiac procedures increase the risk of postoperative mortality. We report a case of operable CTEPH with severe mitral regurgitation causing right heart failure refractory to medical therapy. Emergent PEA combined with mitral valve plasty was considered unacceptably high risk. Although balloon pulmonary angioplasty (BPA) for CTEPH complicated by severe mitral regurgitation carries a risk of worsening pulmonary congestion, we assessed pulmonary artery wedge pressure by right heart catheterization and confirmed that it was not elevated after aggressive diuretic therapy. Therefore, a single BPA session was performed using undersized balloons, with treatment limited to a small number of lesions. This approach stabilized the patient's right heart failure without exacerbating pulmonary congestion and left-sided heart failure. Subsequently, elective PEA combined with mitral valve plasty was successfully performed, resulting in marked improvements in pulmonary hemodynamics and clinical symptoms. This case suggests that rescue BPA followed by elective PEA with mitral valve plasty may benefit selected patients with CTEPH complicated by severe mitral regurgitation and decompensated right heart failure refractory to medical therapy.

Mechanical restoration devices such as the Myosplint® were developed in the early 2000s to reshape left ventricular geometry and delay disease progression in patients with dilated cardiomyopathy. Despite initial safety and feasibility, long-term clinical efficacy remained limited. Today, patients with prior Myosplint® implantation may still present with end-stage heart failure requiring long-term mechanical circulatory support. However, device removal during HeartMate 3™ LVAD implantation may pose technical challenges due to altered myocardial anatomy.