This 70 year old female was known to have a cardiac bruit for 12 years, with a recent onset of angina pectoris. She presented with extreme dyspnoea of 16 hours duration. On examination, a febrile female, BP 110/90 mm Hg, pulse 100 and regular. She had signs of acute pulmonary oedema. A systolic basal thrill was present and a harsh ejection systolic murmur was heard, maximal in the aortic area and conducted up into the neck. Despite treatment, the patient died.
The specimen is of aortic valve viewed from above and laid open by a cut through one commissure. Two of the cusps are partially fused making an apparently bicuspid valve. The cusps are thickened and have masses of calcium projecting upwards. Such a valve may be the result of rheumatic valvulitis.