Rheumatic fever and congestive heart failure

This is the heart of a 44 year old woman who had rheumatic fever and had been treated for congestive heart failure for about one year. There is extreme fibrosis of the mitral valve with fusion of commissures and rigidity of the leaflets, leading to both stenosis and insufficiency. Note that the cordae, which are normally like fine linen threads, look more like ropes here. Note the enormous atrial dilation. As you would suspect, this woman had hypertension.

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