A 55-year-old man with native aortic valve infective endocarditis develops new atrioventricular block and pericarditic pain. Autopsy would most likely demonstrate:
- A Suppurative destruction of the aortic valve annulus extending into the adjacent myocardium ✓
- B Sterile fibrinous vegetations along the closure lines of all four valves
- C Focal endocardial thickening of the left atrium behind the posterior mitral leaflet
- D Calcific nodules on the free margins of the aortic cusps without inflammation
Correct answer: A. Suppurative destruction of the aortic valve annulus extending into the adjacent myocardium
Explanation
Extension of infection beyond the valve cusps into the annulus produces a paravalvular or ring abscess, a feared complication of aortic valve endocarditis. Destruction of conduction tissue traversing the membranous septum explains the new AV block, and abscess rupture can cause purulent pericarditis. Option C describes a MacCallum patch of rheumatic carditis, and option D describes senile calcific aortic stenosis, both sterile processes.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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