CARDIOVASCULAR PATHOLOGY

Published on 07/03/2015 by admin

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Last modified 07/03/2015

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CHAPTER 13 CARDIOVASCULAR PATHOLOGY

INTRODUCTION

DIAGNOSTIC ENDOMYOCARDIAL BIOPSY

CARDIOMYOPATHIES

Table 13.1 Simplified classification of pediatric cardiomyopathies (Richardson et al 1996)

Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy

Histopathological features of cardiomyopathies on biopsy

Dilated cardiomyopathy (Figs 13.113.4)

image

Fig 13.3 Photomicrograph of an endomyocardial biopsy from the same case as Fig 13.2. The myocytes show variation in size, as do their nuclei. There is mild interstitial fibrosis and the endocardium shows mild to moderate, fibroelastic thickening. (Elastic van Gieson)

Hypertrophic cardiomyopathy (Figs 13.5, 13.6)

Table 13.2 Associations of myocyte disarray

Familial hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Normal heart near the insertion of the septum into the ventricular free walls
Congenital heart disease, particularly hypoplastic left heart
Previous biopsy site on endomyocardial biopsy (see section on post-transplant biopsy)
Adjacent to myocardial scars

VIRAL MYOCARDITIS

Differential diagnosis and pitfalls

image

Fig 13.14 Same case as Fig 13.9 stained for fat. Note extensive accumulation of lipid droplets in the myocyte cytoplasm. In this context, the finding of abundant cytoplasmic lipid does not indicate a disorder of fatty acid oxidation. (Frozen section stained with Oil-red-O)

NON-VIRAL MYOCARDITIS

ASSESSMENT OF THE EXPLANTED HEART

CARDIOMYOPATHIES IN THE EXPLANTED HEART

image

Fig 13.20 Same case as Fig 13.19, showing the cannula insertion site at the left ventricular apex. There is dense myocardial fibrosis. Dark flecks of dystrophic calcification are seen at the junction with the myocardium. Suture material is evident on the right. Inflammation is minimal in this case.

Histopathological features of cardiomyopathies in explanted hearts

Dilated cardiomyopathy

Microscopic features (Figs 13.2213.24)

Hypertrophic cardiomyopathy