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Clinical data: The patient underwent correction of congenital pulmonary and aortic valve stenosis, both with manifestations, at 7 years of age. Afterwards, there was progressive residual lesion of both valves, with predominance of regurgitation, and development of acute arrhythmias such as paroxysmal atrial fibrillation, in addition to ventricular extrasystoles. The obstructions were significant, with pressure gradients of 90 and 60 mmHg in the pulmonary and aortic valves, respectively. The patient was asymptomatic, and the loud systolic murmur was accompanied by thrill all over the precordium and neck vessels. There was right ventricular overload on the electrocardiogram (ECG). Double valvoplasty in the three-leaflet valves resulted in a good anatomical solution initially. To date, the patient reports shortness of breath on moderate exertion and precordial palpitations. He is on antiarrhythmic drug (amiodarone), after atrial fibrillation was controlled.  Physical examination: Good general state of health, normal breathing, acyanotic, normal pulses. Weight: 77 kg; height: 181 cm; blood pressure (BP): 110/70 mmHg; and heart rate (HR): 51 bpm. The aorta (Ao) was moderately palpable on the suprasternal notch.  The apical impulse was not palpable on the precordium, and there were mild systolic impulses on the left sternal border. Heart sounds were normal, and there was a grade 1-2/4 coarse systolic murmur in the pulmonic and aortic areas, and a grade 1-2/4 coarse diastolic murmur along the left sternal border. The liver was not palpable and the lungs were clear to auscultation.

Case 6 / 2015 A 27-Year-Old Male Patient with Double Aortic and Pulmonary Valve Lesion after Double Valvotomy in Childhood