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Pulmonary valve (PV) endocarditis is a frequent complication during follow-up in patients with repaired right ventricular outflow tract (RVOT) obstruction and poses relevant diagnostic and treatment challenges. We aimed to describe in details the possible different clinical presentations of this rare condition and to highlight the role of both transthoracic and transoesophageal echocardiography which, in experienced hands, may provide comprehensive useful information for the clinicians.

We below describe the clinical presentation and the echo findings of three cases of pulmonary valve endocarditis complicating disease course after different repair modalities of congenital right ventricular outflow tract obstruction.

The present case series outlines the diagnostic challenges of this increasingly frequent complication during follow-up of patients with congenital RVOT dysfunction after both surgical and percutaneous repair. Despite the diffusion of multimodality imaging, echocardiography with PV-dedicated views play a pivotal role in diagnosing such condition and guiding clinical management. Furthermore, this case series highlight that the suspicion of infective endocarditis should be raised whenever a sudden increase in transvalvular gradient is found during follow-up.

The present case series outlines the diagnostic challenges of this increasingly frequent complication during follow-up of patients with congenital RVOT dysfunction after both surgical and percutaneous repair. Despite the diffusion of multimodality imaging, echocardiography with PV-dedicated views play a pivotal role in diagnosing such condition and guiding clinical management. Furthermore, this case series highlight that the suspicion of infective endocarditis should be raised whenever a sudden increase in transvalvular gradient is found during follow-up.

Heart failure (HF) and atrial fibrillation (AF) are often concomitant and act in a vicious cycle. Atrial fibrillation is associated with greater functional limitations and increased morbidity and mortality in patients with HF. Moreover, AF associated with HF increases patients' physical inactivity, worsening their clinical condition, and prognosis. Exercise training is safe and has clear benefits in HF. However, these benefits have not been demonstrated when AF is associated with HF.

We present the case of a 57-year-old man with permanent AF and HF with reduced ejection fraction, who underwent 12 weeks of exercise training that included cardiopulmonary exercise testing, neuromuscular sympathetic activity (NMSA), and muscle blood flow (MBF) before and after training.

Exercise training was shown to have a potential benefit in reducing the activity of the sympathetic nerve and increasing muscle blood flow, as well as increasing VO

and decreasing the VE/VCO

slope in a patient with AF associated with HF with reduced ejection fraction. These results may indicate favourable clinical implications in this group of patients.

Exercise training was shown to have a potential benefit in reducing the activity of the sympathetic nerve and increasing muscle blood flow, as well as increasing VO2peak and decreasing the VE/VCO2 slope in a patient with AF associated with HF with reduced ejection fraction. These results may indicate favourable clinical implications in this group of patients.

Prevalence of coronary artery calcification is high among patients with advanced age, chronic kidney disease, and diabetes. Percutaneous coronary intervention of heavily calcified coronary artery remains a significant challenge for interventional cardiologists. Although there are several modalities available in treating calcified coronary arteries, lesion preparation of certain heavily calcified vessels remains inadequate prior to stent deployment and/or often associated with worse periprocedural adverse outcomes.

We report feasibility and safety of 3.5 mm peripheral intravascular lithotripsy (IVL) for the treatment of severely calcified coronary stenosis in two patients after orbital atherectomy failed to debulk calcified plaque to enable stent deployment.

Intravascular lithotripsy has recently emerged as a therapeutic option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres in the USA. Studies are ongoing in the safety and efficacy of this technology in treating coronaries.

Intravascular lithotripsy has recently emerged as a therapeutic option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres in the USA. Studies are ongoing in the safety and efficacy of this technology in treating coronaries.

Infective endocarditis is a serious infection associated with high mortality and severe complications, such as heart failure, uncontrolled infection, and embolic events. Decitabine Certain populations, including individuals with a prosthetic valve and those with native valve disease, such as bicuspid aortic valve, are considered to be more at risk of developing infective endocarditis.

A 51-year-old previously healthy male presented with a 2-week history of persistent fever, malaise, and night sweats despite taking a long course of oral antibiotics. Examination was unremarkable; however, blood tests showed elevated inflammatory markers. Three sets of blood cultures revealed coagulase-negative gram-positive cocci (later identified as

), and the patient was subsequently started on IV antibiotics. His echocardiography showed a bicuspid aortic valve with severe regurgitation, and an aortic root abscess surrounding a dilated aortic root. In view of the presence of locally uncontrolled infection, the patient was referred for urgent debridement of the abscess and replacement of the aortic valve with tissue prosthesis. Fortunately, after a total of 6 weeks of IV antibiotics and successful operative management, our patient made a complete recovery.

The development of an aortic root abscess occurs in 10-40% of cases of aortic valve endocarditis. Clinically, this should be suspected in any patient with endocarditis who fails to improve despite appropriate antibiotic therapy. This case demonstrates that severe infective endocarditis can develop in apparently healthy individuals due to underlying cardiac abnormalities.

The development of an aortic root abscess occurs in 10-40% of cases of aortic valve endocarditis. Clinically, this should be suspected in any patient with endocarditis who fails to improve despite appropriate antibiotic therapy. This case demonstrates that severe infective endocarditis can develop in apparently healthy individuals due to underlying cardiac abnormalities.