Case 25-1976

Presentation of CaseAn 82-year-old woman was admitted to the hospital because of substernal pain.There was a history of rheumatic fever in childhood, after which a murmur was noted. At the age of 39 years dyspnea appeared, and it recurred in paroxysmal fashion, often accompanied by atrial fibrillation. At the age of 52 years atrial fibrillation became fixed, and five years later dyspnea limited her largely to her home. At the age of 61 years she underwent a mitral valvuloplasty at another hospital, followed by marked improvement, with resumption of an active life.One year after the operation an . . .