Rheumatic Aortic Valve Disease

Clinical History

This 59 year old male had a past history of rheumatic fever 53 years previously. The patient was well until 10 years prior to presentation, when he noticed the gradual onset of effort dyspnoea associated with palpitations. 3 days before admission, following exposure to cold, he experienced a fluttering feeling in the chest and felt breathless. Examination revealed a dyspnoeic, febrile man. Pulse 146/min and regular, BP 110/80 mm Hg. There was jugular venous congestion of 7.5 cm and the apex beat was in the 5th left intercostal space 13 cm from the mid-sternal line. A systolic murmur was heard maximal in the aortic area. The aortic second sound was absent. Many rhonchi were heard in the lungfields. There was no peripheral oedema. Despite treatment for cardiac failure and bronchopnuemonia, the patient deteriorated and died.

Pathology

The specimen is a heart, the left ventricle being laid open to display the cavity and mitral and aortic valves. The left ventricular cavity is markedly enlarged and the wall hypertrophied (15 mm). The aortic valve is thickened and irregular and shows calcification and fusion of the cusps. Two small slit-like deficits in the cusps, visible at the point of fusion of the right posterior and the anterior cusps, are probably congenital fenestrations. The aorta above the cusps shows some atheromatous deposits. Several of the chordae of the mitral valve are shortened and thickened. The coronary vessels appear normal. There is some whitening of the visceral layer of pericardium.