A 48 year old Japanese man was admitted to our institute with orthopnoea. He had undergone coronary angioplasty for acute myocardial infarction six months before and had not had a follow up since that time. A chest radiograph showed severe pulmonary vascular congestion. No significant coronary lesions were seen on coronary angiography. Detailed transoesophageal echocardiography revealed a thickened mitral leaflet with poor coaptation with severe regurgitation, and a dilated left atrium (Fig 1A). Left ventricular function was preserved (ejection fraction 50%). Laboratory testing revealed thrombocytopenia and the presence of serum lupus anticoagulant …