Abstract
Case 1: A 69-year-old obese female patient experienced recurrent episodes of heart failure over the previous year. She had a history of hypertension, diabetes, chronic kidney dysfunction, atrial fibrillation, mild aortic regurgitation (AR) and mitral regurgitation (MR) and benfluorex intake 150mg t.i.d. between 1976 and 2001. She had no history of rheumatic fever [1]. Clinical examination revealed NYHA III dyspnoea and systolic murmurs. Echocardiography showed mildly calcified AVS (mean gradient 54mmHg, area 0.6cm2), mild AR, moderate restrictive MR (vena contracta 5mm) and severe mitral stenosis (MS) (mean gradient 12mmHg) with thickened leaflet and shortened subvalvular apparatus (Fig. 1A&C).
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