This specimen consists of the aortic valve and surrounding tissue. The valve is tricuspid and shows
an almost continuous line of vegetation along the three cusps. The vegetations are large and
confined to the ventricular surface of the cusps. The coronary ostia are not involved. A degree of
aortic stenosis was described at autopsy, and the heart was enlarged, weighing 580g with the
presence of left ventricular hypertrophy.
History: This man was admitted with a six-month history of ill health, a three-month history of
low back pain, two weeks of diarrhoea and two weeks of intermittent fast palpitations. There were
signs of left ventricular failure. Alpha haemolytic streptococci were isolated from blood cultures.
He was treated vigorously but ultimately died in cardiac failure. The underlying abnormal valve
(aortic stenosis) and long course of illness in this case make the designation of subacute bacterial