On 12-29-02 the patient’s O2 saturations declined and the family decided not to re-intubate the patient per his wishes for non-invasive treatment only.

The patient died on 12-30-02 and an Autopsy was requested. The Autopsy found that the patient had interstitial pneumonitis on top of his already severe interstitial lung disease, this was probably due to viral pneumonia. His heart was enlarged (590 gm) and dilated. There were hemosiderin laden macrophages in the lungs.

	External view of the right ventricle showing enlargement.
	Internal view of the right atrium and ventricle showing dilatation and hypertrophy.
	Picture of the Patent Foramen Ovale when the heart was fresh.
	View of the Patent Foramen Ovale in the fixed heart.
	Cut surface of the lung.
	Close up of the end stage lung disease with interstitial fibrosis.
	Microscopic of heart with hypertrophic fibers.
	Wavy myofibrils consistent with ischemia.
	Sections of lung with end stage honey comb changes.
	Sections of lung with end stage honey comb changes.
	Sections of lung with interstitial inflammation, fibrosis and hemosiderin laden macrophages.
	Sections of lung with interstitial inflammation, fibrosis and hemosiderin laden macrophages.

1. What is this heart disease called?

2. What is the cause of death?

3. What is the significance of the patent foramen ovale?