Subacute Bacterial Endocarditis

Clinical History

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.

Pathology

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.