A young female presented with NYHA class III symptoms, absent lower limb and left radial pulses.Echocardiography showed severe
mitral stenosis and left atrial clot. Abdominal aorta was cut off distal to renal artery with collaterals to lower limb vessels. Left
subclavian artery was totally occluded distal to vertebral artery. She had HLA DR3.
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