The heart was enlarged to 660 grams, and the epicardium was smooth. The right and left coronary arteries were normal. The foramen ovale was not patent. The right and left atria as well as the right and left ventricles were all moderately to severely dilated (Figure 1). The myocardium was red-brown and the right ventricle showed moderate hypertrophy with ventricular wall thickness ranging from 0.4 to 0.6 cm. The left ventricular wall thickness ranged from 0.8 cm at the apex to 1.6 cm near the mitral valve. The mitral valve showed small vegetations measuring less than 0.2 cm and the remaining heart valves were thin and pliable. The circumferences of the mitral and tricuspid valves were enlarged to 14.0 and 15.0 cm, respectively.
The right lung weighted 1500 grams and the left 640 grams. The trachea and bronchi showed bilateral multifocal submucosal hemorrhage. The right lower lobe lung parenchyma was diffusely consolidated with purple, firm, homogeneous tissue (Figure 2). On sectioning, this lobe exuded large amounts of fresh unclotted blood and there were clots in pulmonary veins and in most bronchi. The remaining lung lobes showed multiple hemorrhagic foci, and the remaining lung parenchyma was spongy and tan-gray. The pulmonary arteries were free of emboli and atherosclerosis.
The pectoralis and paraspinal muscles were red-brown and atrophied.