Figure 1: (a-d) Echocardiography demonstrated thickened and doming mitral leaflets suggestive of CRHD. The short-axis view at the level of the mitral valve measures the mitral valve area of 1.5 cm2 using planimetry (a). The continuous-wave Doppler across the mitral valve recorded the peak gradient of 7 mm Hg and a mean gradient of 3 mm Hg (b). Four chamber view revealed thickening of the tricuspid valve with mild dilatation of right atrium and ventricle secondary to tricuspid stenosis and regurgitation (c). The continuous-wave Doppler across the tricuspid valve measured peak velocity of 3.7 cm/s and right ventricular systolic pressure of 58 (48 + 10) mm Hg (d).