Chest x ray, rheumatic heart disease
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This CXR shows replacement of both aortic and mitral valves in a patient with rheumatic heart disease. The mitral valve is most commonly involved, both valves are the second most common occurence, and the aortic valve alone is third in incidence. Rheumatic heart disease occurs following Streptococcus pyogenes infection (Strep throat). It is rare nowadays, since antibiotic therapy is common, but a large number of elderly patients will have sequelae, such as the valve replacement you see here. It is thought to be a Type II hypersensitivity reaction, because of common (or similar) antigens in the bacteria and heart valves.