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A 48-year-old woman presented with progressively worsening exertional dyspnoea. Physical examination revealed an accentuated first heart sound, opening snap and holodiastolic mitral murmur. A transthoracic echocardiogram showed severe rheumatic mitral stenosis (valve area: 0.7 cm2; mean pressure gradient: 23 mm Hg; pulmonary artery systolic pressure: 60 mm Hg), mild-to-moderate mitral regurgitation (MR), with a Wilkins score of 7 and valvular anatomy favourable for percutaneous mitral valvuloplasty (PMV). After three successive balloon dilations, the valve area increased to 1.2 cm2, transmitral gradient decreased to 5 mm Hg and mean pulmonary artery pressure to 33 mm Hg. The patient remained stable after the procedure, asymptomatic during hospitalisation, and routine 2D and 3D echocardiography images were obtained before discharge from hospital (figure 1 and online supplementary videos 1 and 2).
Contributors All authors have read and approved the case. Each author has contributed significantly to the work. AFL was responsible for conception, design, review of literature and writing the case; PHNC and CLG were responsible for the cardiac surgery, LFPB and TCT helped in the design of the case and MCPN made important contributions to interpretation of the images.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
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