This 23-year-old woman presents with palpitations and exertional dyspnoea. She is found to have a loud, continuous murmur on auscultation. Her echo is shown in Figures 20.1, 20.2, 20.3, 20.4, 20.5 and 20.6, and Videos 20.1, 20.2, 20.3, 20.4, 20.5, 20.6, 20.7, 20.8, 20.9, 20.10 and 20.11.