Occlusion of a coronary ostium by an ingrowing endocardial vegetation: a case report.

A 21-year-old primi, with a period of gestation of 35 weeks, was found collapsed in the toilet of a maternity hospital in Colombo, Sri Lanka. She had been admitted five days previously and echocardiography had detected a tight aortic stenosis with grade I aortic regurgitation. At autopsy, the heart showed multiple, large (> 10mm), friable vegetations on a stenosed, bicuspid aortic valve. A 5 mm long part of a vegetation had extended into the ostium of the left main coronary artery and caused an obstruction. Histopathology showed scattered fibrosis and focal inflammatory cell infiltrate in the myocardium. The vegetations on the valve cusp were composed of colonies of bacteria, fibrin exudate and polymorphs. The cause of death was acute myocardial infarction in a pregnant woman due to occlusion of the left coronary artery by an infective endocarditis vegetation. A medline search of the past 25 years failed to find a similar case.