Clinical introduction

A 35-year-old man was referred to our hospital for dyspnoea and prolonged fever of unknown origin for a month. He had a high-pitched pan-systolic murmur at apex radiating to the clavicular area. His laboratory data showed elevated inflammatory indices (white-blood cells 14 800/μL and C-reactive protein 8.26 mg/dL). A chest radiograph revealed a moderate cardiomegaly (cardiothoracic ratio=0.60), and an ECG revealed atrial fibrillation. Transthoracic and transoesophageal echocardiography were performed (see figures 1 and 2, videos 1, 2 and …