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A 40 year old man presented with general malaise, pyrexia, and microembolic phenomena. Blood cultures were positive for α haemolytic streptococcus. A transthoracic echocardiogram showed several small masses on the aortic valve (AV), consistent with vegetations, and severe aortic regurgitation (AR). A large mass was seen on the atrial aspect of the anterior mitral valve leaflet (AMVL) thought to be a large vegetation. A transoesophageal echocardiogram was performed confirming AV vegetations with severe AR and an AMVL aneurysm with associated leaflet perforation and severe mitral regurgitation. The site of AMVL perforation corresponded to the point of impact of the AR jet on the leaflet, creating a “jet lesion”. The primary lesion was therefore AV endocarditis with secondary involvement of the mitral valve. The patient’s haemodynamic state deteriorated and he subsequently underwent aortic and mitral valve replacement.
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