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Examination revealed atrial fibrillation, hypotension, cyanosis, anasarca and a mid-diastolic murmur. 2D transthoracic echocardiography showed bi-atrial enlargement with thickened mitral and tricuspid valves with severe mitral and tricuspid stenosis. Due to refractory shock despite medical management, mitral and tricuspid valve percutaneous balloon dilation was performed, leading to an improvement in haemodynamics, allowing her to be weaned off support and discharged after 3\u2009days.<\/jats:p>","DOI":"10.1136\/bcr-2025-265053","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T23:05:20Z","timestamp":1745449520000},"page":"e265053","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acquired bilateral atrio-ventricular valvular stenosis in a complex single-ventricle physiology following superior cavo-pulmonary connection"],"prefix":"10.1136","volume":"18","author":[{"given":"Aakash","family":"Vijay","sequence":"first","affiliation":[{"name":"Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ankit","family":"Jain","sequence":"additional","affiliation":[{"name":"Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anwar Hussian","family":"Ansari","sequence":"additional","affiliation":[{"name":"Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1136-6353","authenticated-orcid":false,"given":"Devesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"key":"2025082700124147000_18.4.e265053.1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.3329\/cardio.v13i2.52979","article-title":"A Rare Combination of Complex Congenital Heart Disease with Acquired Rheumatic Valvular Heart Disease","volume":"13","author":"Chowdhury","year":"2021","journal-title":"Cardiovasc j"},{"key":"2025082700124147000_18.4.e265053.2","article-title":"Congenital heart disease with rheumatic fever and rheumatic heart disease: a coincidence or an association?","volume":"48","author":"Bokhandi","year":"2002","journal-title":"J Postgrad Med"},{"key":"2025082700124147000_18.4.e265053.3","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951104004081"},{"key":"2025082700124147000_18.4.e265053.4","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1161\/01.CIR.53.2.389","article-title":"Right ventricular growth in a case of pulmonic stenosis with intact ventricular septum and hypoplastic right ventricle","volume":"53","author":"Rao","year":"1976","journal-title":"Circulation"},{"key":"2025082700124147000_18.4.e265053.5","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1962.02080030163009"},{"key":"2025082700124147000_18.4.e265053.6","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(63)90005-5"},{"key":"2025082700124147000_18.4.e265053.7","unstructured":"Salik I , Mehta B , Ambati S . 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