Rheumatic mitral stenosis (MS) is a progressive cardiac disease characterized by the obstruction of blood flow through the mitral valve (MV).1 Echocardiography is crucial for assessing the severity of MS. Low flow through the MV can lead to the underestimation of MS severity by echocardiographic methods.2 Here, we present a case illustrating the underestimation of MS severity due to severe tricuspid regurgitation (TR).

Mitral valve (MV) repair is the guideline-directed, optimal treatment for severe degenerative mitral regurgitation (MR) and often includes the placement of a complete mitral annuloplasty (MA) ring or band (partial ring).1 Recurrent MR occurs in approximately 10% of cases after MV repair.2 Redo MV surgery for recurrent severe MR after MV repair can be high risk.3-5 Mitral valve transcatheter edge-to-edge repair (m-TEER) has been reported to be a successful therapy for recurrent severe MR after MA.

Mitral valve (MV) repair is the guideline-directed, optimal treatment for severe degenerative mitral regurgitation (MR) and often includes the placement of a complete mitral annuloplasty (MA) ring or band (partial ring).1 Recurrent MR occurs in approximately 10% of cases after MV repair.2 Redo MV surgery for recurrent severe MR after MV repair can be high risk.3-5 Mitral valve transcatheter edge-to-edge repair (m-TEER) has been reported to be a successful therapy for recurrent severe MR after MA.

In the usual transcatheter edge-to-edge repair (TEER) of the mitral valve (MV), a device (MitraClip, Abbott Vascular; or Pascal, Edwards Lifesciences Corp.) is positioned perpendicular to the coaptation line between the anterior and posterior MV leaflets, and then a portion of the 2 leaflets is connected together with the device. In this unique case, however, mitral regurgitation (MR) was due to a deep interscallop defect located between the middle (P2) and medial (P3) scallops of the posterior MV leaflet and the flail segment did not face the coaptation line.

Primary cardiac lymphoma is a rare diagnosis.1 Patients most commonly present with heart failure symptoms and are at times simultaneously infected with HIV/AIDS.2 Histopathological findings obtained from cardiac biopsy are the reference standard for diagnosis in these patients; however, the benefits of the biopsy approach must be weighed against a patient’s individual values as well as the overall risks and yield of the procedure. Given the positive response to treatment, cardiac lymphoma should be considered when patients present with new heart failure symptoms and a right-sided mass on imaging.