Mitral Leaflet Flail as a Late Complication of Infective Endocarditis: A Case Report

Infective Endocarditis (IE) refers to an infection of the endocardial surface of the heart which leads to a wide array of complications, including heart failure, perivalvular abscess, metastatic infection, septic embolization, mycotic aneurysms, neurological and renal complications. Mitral leaflet flail (MLF), defined as a failure of leaflet coaptation with the rapid systolic movement of the involved leaflet into the left atrium, is a rare complication of IE which can lead to severe mitral regurgitation. Echocardiography plays a key role in making its diagnosis with transesophageal echocardiograms (TEE), providing greater sensitivity and specificity compared to transthoracic echocardiograms (TTE). MLF is often misdiagnosed, or diagnosis is delayed due to its presentation with non-specific cardiac symptoms. However, early diagnosis with echocardiography and prompt surgical correction leads to improved long-term survival. Here we have presented a case of a 71-year-old female with a past medical history of IE nine years ago who was referred to the cardiology clinic for one month of exertional dyspnea. TTE showed severe mitral regurgitation, and subsequent TEE confirmed flail mitral leaflet.