Since ARNI, a novel complex of the ARB valsartan with a neprilysin inhibitor sacubitril, significantly improved clinical outcomes compared with an ACE inhibitor in the PARADIGM-HF trial [24], a treatment with ARNI is now recommended to replace ACE inhibitors or ARBs in symptomatic patients with HF and a reduced EF [30]. Here, MME is linked to hydrops fetalis.