Clinical introduction

A woman in her 60s was referred for a routine echocardiogram after identification of a systolic murmur by her general practitioner. She was asymptomatic and clinical examination revealed only mild ankle oedema. Medical history included treated hypertension, a right nephrectomy and adrenalectomy 2 years previously for a benign cystic lesion and a 5 cm ovarian cyst under gynaecology surveillance. She had also recently been diagnosed with irritable bowel syndrome (IBS) by gastroenterology.

Transthoracic echocardiography demonstrated thickening of the tricuspid valve with severe regurgitation and a pulmonary artery systolic pressure of 55 mm Hg (figure 1). There was also mild to moderate mitral regurgitation and mild left ventricular dysfunction, …