Echocardiography showed reduced systolic function, severe tricuspid regurgitation 3+, moderate mitral regurgitation 2+, and moderate aortic regurgitation 2+. N-terminal pro-brain natriuretic peptide (NT-proBNP) was 1000 ng/l (n, <125 ng/l). The gene discussed is NPPB; the disease is mitral valve insufficiency.