The following electronic only articles are published in conjunction with this issue of Heart.

Rheumatic involvement of all four cardiac valves

K Jai Shankar, P K Jaiswal, K M Cherian

Rheumatic involvement of all four heart valves is rare. A 35 year old woman presented with gradually progressive exertional dyspnoea for the preceding 10 years. On evaluation she was in atrial fibrillation with congestive heart failure. Clinical examination found evidence of stenosis of the mitral aortic and tricuspid valves with a history of rheumatic fever in childhood. Transthoracic echocardiography showed the involvement of all four cardiac valves. Few reports are available in the literature describing rheumatic quadrivalvar damage. Operator awareness of possible rheumatic involvement of all four valves is essential for appropriate diagnosis.

(Heart 2005;91:e50) www.heartjnl.com/cgi/content/full/91/6/e50

Fatal infection after rapamycin eluting coronary stent implantation

F Alfonso, R Moreno, J Vergas

Septic complications after coronary stenting are extremely rare. The occurrence of cardiac related sepsis after rapamycin eluting stent deployment has not been previously reported. The potential role of drug eluting stents in locally blunting the innate response to bacterial agents is discussed.

(Heart 2005;91:e51) www.heartjnl.com/cgi/content/full/91/6/e51