BMJ Case Reports 2012; doi:10.1136/bcr.08.2011.4593
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Cardiac necklace in rheumatic heart disease

  1. Manjunath C Nanjappa
  1. Cardiology Department, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
  1. Correspondence to Dr Rajiv Ananthakrishna,{at}


A 45-year-old male, a known case of rheumatic heart disease (RHD), presented with New York Heart Association (NYHA) class III breathlessness of 6 months duration. There was no history of tuberculosis, diabetes mellitus or chronic kidney disease. A transthoracic echocardiogram showed severe mitral stenosis with an orifice area of 0.9 cm2 and a valve gradient of 23/16 mm Hg. The Wilkins score was 9 (leaflet mobility 3, valvular thickening 3, subvalvular fusion 2 and calcification 1). Percutaneous transluminal mitral …

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