An aortic cusp shows vegetation with fibrinous exudate on the free edge and organization in the basal portion (a). Bacterial colonies present in fibrinous exudate appear dark purple(b). Neutrophilic infiltrates in the granulation tissue are indicative of ongoing infection (c). Macrophages and multinucleated giant cells are common in streptococcal endocarditis with subacute presentation.
In healed endocarditis the gross pathology is different