Artificial aortic valve- the valve is visible on the coronary angiography done postmortem. The native coronary arteries do not show anastomosis.
Additional finding: Acute to subacute myocardial infarction. Almost the entire anterior and posterior wall of the left heart and the septum are involved (so-called panic infarction). Fresh thrombotic material is located in both branches of the left coronary; another thrombus is found in the aortocoronary bypass on the Ramus intermedius of the left coronary. Multiple intramyocardial thrombus as well.
Clinical presentation: 73 year old female patient with severe aortic stenosis and coronary heart disease. Replacement of the aortic valve and triple bypass. Severe cardiac insufficiency post surgery. Acute renal insufficiency. Increasing troponin, fresh infarction?