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The dog died 138 days after discharge, and the clinicians performed a necropsy (post-mortem examination) which revealed advanced (Type 4) lesions on the mitral valve leaflets, enlargement of the two left heart chambers, several lesions within the left atrium, attributed to jets of blood regurgitating through the mitral valve, extensive damage to the endothelial cells of the left atrium, and the ASD and a blood clot trapped within the ASD