A 24-year-old man presented with a short history of fever and swollen lower limbs. Physical examination revealed signs of significant mitral regurgitation and blood cultures grew Streptococcus viridans. Transoesophageal and transthoracic echocardiography demonstrated prolapse of the mid-portion (P2) of the posterior mitral valve leaflet with severe mitral regurgitation. There was a 9mm by 9mm vegetation attached to the abnormal leaflet . Echocardiography also identified a 10mm secundum atrial septal defect with left to right shunting of the mitral regurgitation jet through the defect . Along the inferior left atrial side of the septal defect were multiple small mobile masses in keeping with endocarditis of the atrial septum . The patient was treated with a four-week course of antibiotics with rapid clinical improvement and resolution of the vegetations.
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