Aortic regurgitation and unusual diastolic mitral regurgitation

In patients with infective endocarditis affecting the aortic valve, a secondary involvement of subaortic structures may occur in a mechanism of direct extension or as a result of an infected jet of aortic regurgitation striking the ventricular surfaces of the mitral-aortic intervalvular fibrosa and the anterior mitral leaflet (AML). We present a 29-year-old male with infective endocarditis of the bicuspid aortic valve, who developed a secondary infection of the subaortic tissues complicated by a perforation of the AML. Echocardiographic examination revealed not only systolic, but also diastolic mitral regurgitation.