25499              MITRAL AND AORTIC PROSTHESIS

The patient was a man aged 44 at death.  He had rheumatic heart disease at the age of 9, with residual mitral and aortic valvular lesions.  At the age of 37 he has treated at the R.A.H. for subacute bacterial endocarditis.  At the age of 43, cardiac catheterisation showed moderately severe aortic and mitral incompetence, and the aortic and mitral valves were replaced with cloth-covered Starr-Edwards prostheses.  He recovered uneventfully from the operation, but was admitted 10 months later with increasing congestion failure and probable subacute endocarditis, although blood cultures were negative.  Finally he suffered a cardiac arrest from which he could not be resuscitated.

The prostheses in the mitral and aortic valves are visible.  The mitral prosthesis is covered with a thin tough layer of antemortem thrombus, and there is much fibrosis of the endocardium between the mitral and aortic valves.  A small amount of antemortem thrombus is present around the supporting ring of the aortic prosthesis.