Bacterial Endocarditis Complicated By Rupture of Aortic Valve Cusp

Clinical History

The patient presented with mild fever and joint pains. On examination temperature was 38.5_C, a systolic and early diastolic murmur was present over the left sternal edge and the spleen was palpable. Urine analysis revealed microscopic haematuria. He developed intractable cardiac failure and died.

Pathology

The specimen is of a heart laid open to display the left ventricular cavity, the aortic and mitral valves. The left ventricle is moderately hypertrophied (13-15 mm) and dilated. The non-coronary cusp of the aortic valve has been largely replaced with a rounded perforation 5 mm in diameter through the base of the cusp. A less severe endocarditis is present on the adjacent left posterior cusp and on the left ventricular wall extending downwards for a short distance. This is an example of subacute bacterial endocarditis. The causative organism isolated by culture was Streptococcus viridans.