A 77-year-old woman underwent mitral valve replacement and tricuspid
annuloplasty for severe mitral stenosis and tricuspid regurgitation with
pulmonary hypertension. Two months later, the patient was readmitted
because of marked edema. A new harsh pansystolic murmur was auscultated,
and echocardiography revealed a jet from the left ventricle to the right
atrium but no perivalvular leakage was detected at the mitral valve
position. At operation, an 6mm defect adjacent to the tricuspid annulus
in the interatrial septum and detachment of the anterior edge of the
tricuspid ring were detected. The defect was closed using a pericardial
patch. An inadequate stitch at the anteroseptal commissure in the
previous operation led to left ventricular-right atrial communication.