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The features and course of a patient in whom a fistula developed between the left ventricle and the coronary sinus following replacement of a faulty mitral valve prosthesis are described. The subsequent deterioration of her condition was associated with a pansystolic murmur and periprosthetic regurgitation. Replacement by a third prosthesis was complicated in addition by tricuspid regurgitation. The fistula was not suspected until the fourth operation, when the right atrium was opened for tricuspid annuloplasty. The fistula was repaired successfully, and the woman has made good progress postoperatively.
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