An 18 year old man was admitted with progressively increasing chest pain of one year's duration and palpitation, breathlessness, and oedema of the lower limbs that had lasted for three months. On examination there was ankle oedema; the blood pressure was 90/60 mm Hg and the jugular venous pressure was 7 cm from the sternal angle with prominent V waves and Y descent. The apex beat was easily fel...