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A patient is described in whom a continuous murmur was caused by the combination of rheumatic mitral stenosis and a rare form of partial anomalous pulmonary venous drainage. In this case, the left superior pulmonary vein drained into the left atrium and also into a large anomalous vein which then drained to the right atrium via the innominate vein and superior vena cava. At surgery, mitral commissurotomy and then ligation of the anomalous vein were performed with a good result; the continuous mur-mur was no longer audible after operation. The embryology, physiology, auscultatory findings and surgical consideration are discussed