An unusual cause of severe mitral regurgitation in a patient with aortic valve endocarditis.

61-YEAR-OLD, 69-kg, 173-cm previously active man with a past medical history of hyperlipidemia, type-II diabetes mellitus, and pancreatitis was admitted to the authors’ institution for evaluation of low-grade fever, drenching night sweats, malaise, and progressive dyspnea on exertion of 2 weeks’ duration. He denied weight loss, productive cough, orthopnea, and chest pain. The physical examination was notable for a grade III of VI holosystolic murmur heard best at the apex with radiation to the axilla. The white blood cell count was normal. A chest radiograph was unremarkable. Transesophageal echocardiography was performed as part of the diagnostic evaluation and revealed the images shown in Figs 1 and 2 and Video clips 1 and 2). What is the diagnosis?