A 75 year old lady who had mitral valve replacement 13 yrs ago has developed recurrent breathlessness. Her husband has noticed prominent pulsation in her neck. She complains of abdominal pain and ankle swelling. What is the most probable diagnosis?

The key is D. Tricuspid regurgitation. [Long standing complication of mitral valve replacement is

tricuspid regurgitation. In tricuspid regurgitation there is recurrent breathlessness (mostly exertional),

prominent pulsation in the neck (giant V wave), abdominal pain due to enlarged congested liver, ankle

oedema due to right heart failure].