For each of the valvular abnormalities on the left select the most appropriate association from the list of conditions on the right

The answer is D, C, A. Mitral stenosis and aortic incompetence are a common result of chronic rheumatic heart disease.

Mitral incompetence due to myxoid degeneration of the valve cusps occurs in the rare Marfan's syndrome: the 'floppy' mitral valve syndrome has similar histological features but is not associated with congenital anomalies.

In the carcinoid syndrome metastatic carcinoid tumour is associated with release of 5-hydroxytryptamine into the systemic circulation, causing fibroblastic proliferation in the valve cusps and ring. Bicuspid aortic valve (B) is a common congenital anomaly. Senile changes in heart valves are usually related to calcification of the cusps (E).