40 year old woman with chronic valvular heart disease was admitted for congestive heart failure.
The aortic cusps show whitish fibrous thickening with rigidity and retraction; narrowing the aortic outlet (aortic stenosis) but not allowing complete closure (aortic regurgitation/ incompetence). There is associated fibrous thickening and shortening of the chordae tendinae (indicating mitral valve involvement). No vegetations are seen. The left ventricle is hypertrophied. The pulmonary valve is grossly normal.
The left atrium shows marked dilatation of the chamber due to mitral valve stenosis (not shown). No mural thrombus is seen