CASE HISTORY

This specimen was incidental findings in a woman who died from massive metastases in the spleen seven years after hysterectomy for adenocarcinoma of the body of the uterus. The calcification of the aortic valve was visualized radiologically as was the enlargement of the left atrium. 

PATHOLOGY

Heart section 160mmx150mmx18mm. The atrio-ventricular part of the heart has been mounted. At postmortem the heart weighed 499g due mainly to the left ventricular hypertrophy. The coronary arteries have been injected with radio-opaque material for the study of the coronary circulation but this did not show any significant abnormalities. The most striking lesion is the presence of a bar joining the aortic and posterior cusps of the mitral valve leaving two unequal orifices. The aortic cusp of the mitral valve shows considerable calcification which is visible from the ventricular aspect as raised white nodules. The aortic valve is congenitally bi-cuspid, the two cusps being of equal size and the slit-like orifices being centrally placed. There is, in addition, considerable calcification in the sinuses of Valsalva and also on the ventricular aspect of the valve. This has caused aortic stenosis which is responsible for the ventricular hypertrophy. The pulmonary and tricuspid valves appear healthy. The aorta shows a relatively mild coarctation situated between the origin of the left subclavian and the site of the obliterated ductus arteriosus. This coarctation is not narrow enough to be of clinical significance and it was quite unsuspected during life, and at postmortem there was no development of the collaterals. In addition to the coarctation there is a peculiar dilation around the origin of the left subclavian artery.