Quadrivalvular heart disease of mixed congenital and rheumatic aetiology with concomitant ostium secundum atrial septal defect and Ebstein's anomaly of the tricuspid valve

We describe a 34-year-old man with an ostium secundum atrial septal defect, Ebstein 's anomaly of the tricuspid valve with severe tricuspid regurgitation, congenital valvular pulmonary stenosis, rheumatic mitral stenosis and regurgitation with aortic regurgitation, who presented with decompensated heart failure after developing atrial fibrillation. The complex haemodynamic interplay of these lesions is also discussed.