Acquired bilateral atrio-ventricular valvular stenosis in a complex single-ventricle physiology following superior cavo-pulmonary connection.

A young female in her early 20s with complex congenital heart disease, previously treated with pulmonary valvotomy and a bidirectional Glenn procedure (for hypoplastic right ventricle, severe pulmonary stenosis and ASD) presented with worsening dyspnoea (NYHA IV), anasarca, fever and cough. 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 days.