A Rare Presentation of Rheumatic Heart Disease: Severe Pulmonary Tricuspid and Mitral Stenosis Successfully Treated by Triple Balloon Valvuloplasty

This case report describes a unique occurrence of rheumatic heart disease (RHD) with severe mitral, tricuspid, and pulmonary stenosis in a 17-year-old female. The patient presented with progressive exertional dyspnea and dependent edema. She had a history of acute rheumatic fever and joint pain 5 years ago. Evidence of congestive heart failure, such as pitting pedal edema, hepatomegaly, and elevated jugular venous pressure, was noted on presentation. The electrocardiogram (ECG) revealed important diagnostic information and signs consistent with right ventricular and right atrial enlargement. Chest radiography revealed cardiomegaly with an uplifted cardiac apex and elongation of the right heart border (enlargement of the right atrium and right ventricle). Echocardiography was suggestive of severe pulmonary, tricuspid, and mitral stenosis with mild mitral and tricuspid regurgitation. The patient's prognosis remained challenging, but she had dramatic symptomatic improvement after percutaneous triple valve balloon valvuloplasty. She was discharged after 5 days without any complications.