Perforated mitral valve annular phlegmon with ventriculo-atrial fistula.

Herein we describe a case of perforated mitral valve annular abscess/phlegmon that presented as a new pan-systolic murmur in the setting of hallux osteomyelitis requiring amputation. We discuss the investigations, imaging and complex management challenges arising from this rare condition and the importance of considering a diagnosis of infective endocarditis in patients with a new cardiac murmur.