42 year old man with chronic valvular heart disease was admitted for congestive heart failure.
The left ventricle is hypertrophied and dilated. The aortic cusps show whitish fibrous thickening with rigidity and retraction; narrowing the aortic outlet (aortic stenosis) but not closing completely (aortic regurgitation/aortic incompetence). There is fibrous thickening and shortening of the chordae tendinae (indicating mitral valve involvement).
No friable vegetations are seen.
The left atrium shows endocardial fibrosis and dilatation of the chamber due to mitral valve stenosis (not shown).