The incidence of cardiovascular disease is greatly increased in the HIV-infected population compared with people of the same age without HIV. Cardiovascular manifestations of HIV/AIDS include, but are not limited to, accelerated atherosclerosis, pulmonary arterial hypertension, vasculitis, myocarditis, cardiomyopathy, pericardial diseases, malignancy (myocardial Kaposi sarcoma and B-cell immunoblastic lymphoma), and endocarditis. Drug effects and interactions that challenge the cardiovascular system are even more prevalent in this population, and careful review and surveillance of medication effects is crucial as is careful selection of highly active antiretroviral therapy. A focused assessment and understanding of disease prevalence and presentation is needed as symptoms may be non-specific and cardiovascular physical examination findings indeterminate due to co-morbid conditions in the patient population now living with chronic HIV infection.

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The replacement of surgically corrected mitral valves, also known as percutaneous transcatheter repair, is a relatively young field. Even though these procedures are usually successful, they can present significant intraoperative or postoperative challenges. To our knowledge, we present the first case of acute focal dehiscence of mitral ring repair during the mitral valve-in-ring procedure. K E Y W O R D S imaging angiographic/fluoroscopic, imaging TTE/TEE, mitral valve disease, paravalvular leak, transseptal catheterization