case_images: PMC6713097_01
case_images: Macroscopic view of the right side of the heart, showing downward ventricular insertion of the tricuspid valve ring ("atrialization of the right ventricle"), leaflets partially adherent to the ventricular wall and free portion dysplastic. It also shows a right ventricle with minimal chamber and a "canal" outlet chamber to the pulmonary valve, due to the mal-positioned tricuspid leaflets (source: INMLCF, I.P., with permission).
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case_images: PMC6713097_01_TFSR_A_1595351_F0001_C.jpg
case_images: F0001
case_images: His heart weighed 380.0 g and measured 14.7 cm x 12.0 cm, with global dilatation and congenitally malformed tricuspid valve, including downward ventricular insertion of the ring - "atrialization of the right ventricle" - as in the Ebstein Disease (Figure 1).
case_images: PMC6713097_02
case_images: Macroscopic view of the Quadricuspid Pulmonary Valve, with three equal-sized cusps and an extra (No. 4) smaller one (source: INMLCF, I.P., with permission).
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case_images: PMC6713097_02_TFSR_A_1595351_F0002_C.jpg
case_images: F0002
case_images: His heart revealed nothing abnormal but a congenitally malformed Quadricuspid Pulmonary Valve (Figure 2).
case_images: PMC6713097_03
case_images: Macroscopic view of the Bicuspid Aortic Valve, type 1, showing major degenerative deformation (A), with fibro-sclerosing nodules (*) and dystrophic calcification ( ) exhibited on the histological section (B: HE, x40) (source: INMLCF, I.P., with permission).
case_images: TFSR_A_1595351_F0003_C.jpg
case_images: PMC6713097_03_TFSR_A_1595351_F0003_C.jpg
case_images: F0003
case_images: His heart weighed 440.0 g, with hypertrophy and severe degenerative alterations of a congenitally malformed Bicuspid Aortic Valve (Figure 3).
case_images: PMC6713097_04
case_images: (A) Macroscopic view of the Floppy Mitral Valve, showing the upward ballooning and thickening of the leaflets. (B, C) Microscopic aspect of the mitral valvular acid mucoid deposits, which are Alcian Blue positive (* and oval area) (PAS-AB, x40 and x100) (source: INMLCF, I.P., with permission).
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case_images: PMC6713097_04_TFSR_A_1595351_F0004_C.jpg
case_images: F0004
case_images: Her heart weighed 362.5 g and measured 14.5 cm x 11.0 cm, with dilatation and prominent ballonization of the mitral valve leaflets, as in Myxomatous Mitral Valve Prolapse (Figure 4).
case_images: PMC6713097_05
case_images: Macroscopic image (A). Histopathologic features of Cardiac Fibroelastoma, with papillary architecture (B: HE, x100), fibrous axis of the stalk and branches (C: MT, x100) and a closer view of the elastic component and the endothelial superficial monolayer (D: EvG, x400) (source: INMLCF, I.P., with permission).
case_images: TFSR_A_1595351_F0005_C.jpg
case_images: PMC6713097_05_TFSR_A_1595351_F0005_C.jpg
case_images: F0005
case_images: The heart weighed 1 140.0 g, was dilated and presented a Papillary Fibroelastoma of the Pulmonary Valve (Figure 5).
case_images: PMC6713097_06
case_images: Macroscopic view of the vegetations (A) on the mitral valve, with leaflet perforation (B) on the aortic valve, with cusp tear. (C) Microscopic image of the Endocarditis vegetations with aggregates of Gram + bacteria (Gram, x100) (source: INMLCF, I.P., with permission).
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case_images: F0006
case_images: The heart weighed 580.3 g, was hypertrophic and showed perforated, bi-valvular (mitral and aortic), Infectious (Gram+ bacteria) Acute Endocarditis (Figure 6).
case_images: PMC6713097_07
case_images: Macroscopic view of the mitral valve with thickening and commissures fusion, acquiring the aspect of "smiling face" or "fish mouth" (A). Microscopic image of Post-Inflammatory (Rheumatic) Valvulopathy, with fibroelastosis (*) and thick-wall vessels at the distal part of the leaflets (<<) (B: EvG, x200) (source: INMLCF, I.P., with permission).
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case_images: PMC6713097_07_TFSR_A_1595351_F0007_C.jpg
case_images: F0007
case_images: The heart weighed 393.7 g, with hypertrophy and stenotic aortic-mitral valves, the latter displaying a "smiling face" or "fish mouth" pattern, suggesting Post-inflammatory Valvular Cardiopathy, of Rheumatic nature (Figure 7).
case_images: PMC6713097_08
case_images: Macroscopic view of the Degenerative deformed aortic valve with thickened and extensively calcified cusps (A). Histopathologic features show calcifications ( ), fibroelastosis (*) (B: EvG, x40) and fibrosis of the cusps (C: MT, x40) (source: INMLCF, I.P., with permission).
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case_images: PMC6713097_08_TFSR_A_1595351_F0008_C.jpg
case_images: F0008
case_images: The heart revealed severe mitro-aortic Degenerative Valvular Cardiopathy (Figure 8).
case_images: PMC6713097_09
case_images: Macroscopic images of the Pannus (indicated by red arrowheads), partially covering the aortic valve prothesis (A: superior (aortic) view; B: inferior (left ventricular) view). Histopathologic features show rare capillary vessels, scarce mononuclear inflammatory cells (C: HE, x200), fibroelastosis (D: EvG, x100), and fibrosis (E: MT, x40) (source: INMLCF, I.P., with permission).
case_images: TFSR_A_1595351_F0009_C.jpg
case_images: PMC6713097_09_TFSR_A_1595351_F0009_C.jpg
case_images: F0009
case_images: The heart weighed 637.5 g, presenting ventricular hypertrophy and aortic valve prothesis closing and opening malfunction due to Pannus (Figure 9).