The heart has been cut to show the heart valves on the facing surface. Some calcification
of the aortic cusps is apparent, but the mitral valve shows severe disease - the cusps are
thickened and the orifice is stenotic with a fish-mouth appearance. No vegetations can be
seen. The left atrial wall is thickened. The clot seen in the atrial appendage is post-mortem
in origin. On the reverse side of the specimen there is marked left ventricular hypertrophy.
The changes in the mitral valve are likely secondary to previous rheumatic carditis.
This woman was admitted at the age of 92 with a three-week history of increasing
dyspnoea. She had had a cerebrovascular accident 9 years previously, with residual hemiparesis.
She was treated for left ventricular failure, but later developed bronchopneumonia from which she