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Ebstein's anomaly of tricuspid valve with rheumatic mitral stenosis: a rare association

A 16-year-old girl presented with progressive exertional dyspnoea and palpitations of 3-year duration. The medical history revealed one episode of fever with migratory polyarthritis at the age of 7 years, but it was not further evaluated. On presentation, she was in sinus rhythm with a pulse rate of 88/min and blood pressure of 110/80 mm Hg. Examination revealed a tapping apical impulse in the fifth intercostal space, inside the mid-clavicular line, and a grade 3 parasternal heave. Auscultation revealed loud S1 with an opening snap. There was a mid-diastolic rumble at the apex, with presystolic accentuation. A pansystolic murmur of tricuspid regurgitation was audible. Basal crepitations and peripheral oedema were absent. Transthoracic echocardiography revealed severe rheumatic mitral stenosis (MS) (video 1) (peak and mean mitral valve …