Subacute Bacterial Endocarditis
A 43 year old woman developed a low grade fever and joint pains following a dental extraction. On examination, the temperature was 38.6_C, pulse 130 and there was a systolic and early diastolic murmur in the aortic area. Blood cultures grew Streptococcus viridans.
The heart is laid open to display the left ventricle, mitral and aortic valves. The non-coronary cusp of the aortic valve presents a large nodular vegetation and a perforation 5 mm in diameter. The adjacent cusp and ventricular endocardium show a few small vegetations.