The left auricle is dilated and the endocardium is thickened. The mitral valve cusps are markedly
thickened and rigid producing a crescentic fish mouth-like opening. The aortic valve shows some
nodularity of the cusps but was probably functionally normal.
This elderly woman had rheumatic fever as a child. She was admitted to hospital with
peripheral vascular disease and died in congestive heart failure with pneumonia. At autopsy, a
recent myocardial infarct was found as well.