Ulcerative S. mitis endocarditis of the left and noncoronary cusps of the aortic valve with total destruction of the valve commissure with erosion deep into the aortic root. Note fusion of the commissure consistent with old rheumatic heart disease. View of the left atrial wall and mitral valve. The bulge was caused by a large atrial septal abscess that had ruptured into the left atrium. Note rheumatic changes of the chordae tendineae.
Microscopic section includes the atrial septum, tricuspid valve and interventricular septum.
Cut section of the spleen demonstrating three organizing subcapsular infarcts due to extracardiac embolization from the aortic valve vegetation. Summary S. mitis endocarditis. Underlying rheumatic heart disease. Severe periodontal disease. Persistent hiccoughs consistent with diaphragmatic irritation secondary to splenic emboli and infarction.