Mitral valve prolapse (MVP) is among the most frequently diagnosed valvular heart diseases, with the majority of patients being asymptomatic. However, MVP may also present with ventricular arrhythmias (VA) or sudden cardiac death (SCD). The arrhythmic form of MVP and the complicated course of this condition are closely associated with mitral annular disjunction (MAD). MAD alters the anatomical integrity of the mitral annulus and is thought to contribute to leaflet degeneration and myocardial fibrosis, creating a substrate for malignant arrhythmias. The most common complications associated with MVP and MAD include progressive mitral valve regurgitation, left ventricular hypertrophy and an increased risk of SCD. Cardiac magnetic resonance (CMR) imaging is the most sensitive modality for detecting MAD and myocardial fibrosis and is thus essential for early diagnosis and risk stratification. This review aims to enhance recognition of MAD, summarize current diagnostic and risk assessment strategies, and provide clinical context through two cases of patients with arrhythmic MVP and MAD.

Background and Clinical Significance: Infective endocarditis is a disease of the endocardial surface of the heart, most often affecting heart valves (native or prosthetic) or intracardiac device. Although relatively rare, it carries high embolic risk of complications and mortality. Complete device extraction is recommended; however, conventional surgery may be prohibitive in frail patients with multiple comorbidities. Case presentation: We present a case of a 74-year-old male with implantable cardioverter-defibrillator (ICD)-related infective endocarditis and large lead-associated vegetation measuring approximately 3 cm in size. Due to a high operative risk assessed by Euro SCORE II, a minimally invasive percutaneous approach using the Penumbra vacuum-assisted aspiration system was selected. The procedure enabled successful debulking of the vegetation, followed by complete device removal and targeted antibiotic therapy. The patient’s clinical condition improved, with normalization of inflammatory markers and no recurrence of infection, and a new ICD was safely reimplanted after recovery. Conclusions: This case highlights the potential role of percutaneous vacuum-assisted aspiration as an effective and less invasive therapeutic option in high-risk patients with CIED-related infective endocarditis, particularly when conventional surgical management is contraindicated or requires bridging therapy until the patient’s status is stabilized.

Background and Objectives: Transcatheter aortic valve replacement (TAVR) in large aortic annuli poses challenges due to limited valve-size options and increased complication risks. The aim is to evaluate the safety and performance of XL sizes (30.5 mm and 32 mm) of the Myval transcatheter heart valve (THV) for treating patients with severe aortic stenosis and large aortic annuli. Material and Methods: This retrospective observational study included consecutive patients undergoing TAVR with XL sizes of the Myval THV between December 2023 and December 2024 at a single centre. During this period, 146 TAVI procedures were performed, of which 15 patients (10.3%) with large aortic annuli (mean systolic annular area 786.5 ± 48.2 mm²) received XL valves and were included in the present analysis. Patients were followed up at discharge, 3–6 months, and 1 year. Patient evaluation included echocardiography and clinical assessments following the Valve Academic Research Consortium-3 criteria. Results: All patients were male, with a mean age of 79.1 ± 5.9 years. Technical success was achieved in 100% of cases. At discharge, none of the patients had moderate or greater paravalvular leakage (PVL); 11 patients had no PVL, while 1 had trace and 3 had mild PVL. The mean effective orifice area (EOA) improved from 0.75 ± 0.15 cm² at baseline to 2.31 ± 0.21 cm² at discharge (p < 0.0001). At the 12-month follow-up, the mean EOA was 2.4 ± 0.3 cm², and no moderate or severe PVL or major adverse clinical outcomes were observed. One patient required a permanent pacemaker implantation due to an atrioventricular block. Conclusions: The XL sizes of Myval THV showed both safety and efficacy in patients with large aortic annuli, demonstrating acceptable hemodynamic performance and low complication rates. However, large-scale studies with longer follow-ups are needed to validate these findings in diverse populations.