Rheumatic Mitral Valve Disease with Left Atrial Thrombus

Clinical History

This 70 year old male had a past history of rheumatic fever. He was reasonably well until 3-4 days prior to admission when he developed a chest infection with productive cough. This was associated with marked shortness of breath. Examination revealed a dyspnoeic man, BP 100/70 mm Hg, pulse 150 and fibrillating, respiratory rate 50. Pulse rate at the apex was 176. There were 5-10 cm of jugular venous congestion and cardiomegaly. An apical bruit and thrill were present. There was no peripheral oedema. The patient did not rally despite treatment and died two days following admission in pulmonary oedema.

Pathology

The specimen is of heart with left atrium and ventricle laid open to display the chambers and the mitral valve. The atrium is markedly enlarged and contains a large, ovoid, laminated, antemortem thrombus 6 cm in maximal diameter. There is moderate 12-15 mm hypertrophy of the left ventricular wall with some patchy fibrosis especially of papillary muscle on the right. The mitral valve is thickened and the associated chordae shortened and thickened. The posterior aspects of this specimen shows an enlarged right atrium and ventricle.