Forgotten but not extinct: lessons in hemodynamics and imaging from pancardiac rheumatic heart disease

Simultaneous valvular, pericardial and myocardial involvement from chronic rheumatic heart disease is a rare phenomenon. We describe a novel patient with simultaneous aortic stenosis, mitral stenosis, constrictive pericarditis and pathologic myocardial rheumatic involvement. Lessons and pitfalls of the catheterization hemodynamics for concomitant multivalvular disease and constrictive physiology are outlined. Echocardiographic, computed tomographic (CT) imaging and pathologic findings are presented for the pancardiac involvement in this case.