A 43-year-old woman with a past history of rheumatic fever, presents with exertional dyspnoea over a few months. Her echo is shown in Fig 12.1, 12.2, 12.3, 12.4 and 12.5, and in Videos 12.1, 12.2, 12.3, 12.4, 12.5, 12.6, 12.7 and 12.8.