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PubMedDate not supplied

"Quilty effect" in heart transplantation: is it related to acute rejection?

"Quilty effect" is a lymphocytic infiltrate bulging in the endocardium of cardiac allografts with or without affectation of myocardium. It has been related with cyclosporine treatment. We have reviewed the morphology of 527 endomyocardial biopsy specimens from 46 transplant patients to study the significance and relation of Quilty effect with acute rejection. Paraffin immunoperoxidase studies were performed in 56 cases with Quilty effect or acute rejection. We graded acute myocardial rejection into four degrees according to the Hannover classification. A total of 126 biopsy specimens (24%) showed Quilty effect. Fifty-nine specimens (46.8%) showed different degrees of acute rejection in addition to Quilty effect. If we consider specimens with acute rejection grade greater than or equal to II, which require treatment, the frequency of the association of Quilty effect and acute rejection is statistically significant (p less than 0.01). In cases of acute rejection, the percentage of cases with Quilty effect was higher in cases with the highest degrees of acute rejection. The response of acute rejection to antirejection treatment was similar in all cases with or without Quilty effect. Immunohistochemical study showed a predominance of T lymphocytes in both Quilty effect and in the myocardium of acute rejection. We conclude that Quilty effect is a manifestation of acute rejection, modified by many factors, such as cyclosporine treatment. The finding of isolated Quilty effect may signal the prompt development of an acute rejection episode.

Biopsy↗
PubMed1991

[Percutaneous endocardial Nd-YAG laser energy: experimental studies of ablation of the ventricular myocardium].

The in vitro and in vivo effects of endocardial laser ablation were assessed. Energy was supplied by a Nd-YAG laser (wavelength approximately 1064 nm) and transmitted via a quartz core fiber (phi: 0.4 mm) housed within a specially designed 7 F catheter. In vitro, the effects of increasing output power (5, 10, 20, 40 watt) and impulse duration (1, 2, 4, 8 s) on lesion size were assessed in myocardial preparations of canine hearts. Preparations were superfused with saline or blood, respectively; the distance of the optical fiber to the endocardium was 5 mm. Lesion size increased in diameter (range: 0-4.0 mm) and depth (range: 0-5.2 mm) in a power- and time-dependent manner. Superfusion with blood significantly enhanced the diameter of the lesions, whereas depth of the lesions significantly decreased. In 16 anesthetized mongrel dogs, a total of 52 laser impulses (output power: 10, 20, 40 w; impulse duration: 1, 2, 4 s; energy: 10-160 J) were delivered to apical and apico-inferior sites of the left ventricle. Postmortem, 40 lesions with a diameter of 2.6-19.4 mm and a depth of 3.7-16.2 mm were found. 19 lesions revealed central vaporized craters with a depth up to 11.2 mm. Perforation of the left ventricle occurred in two cases following 80 and 160 J, respectively. In vitro and in the intact animal (in apical and apico-inferior sites of the left ventricle) endocardial laser ablation is feasible to induce distinct myocardial lesions in a power- and time-dependent manner.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Subendocardial hemorrhage from the forensic medicine viewpoint].

The histological examination of cardial tissue samples concerning routine autopsy casework showed microscopic discrepancies in case of macroscopically found "subendocardial haemorrhages". In an attempt to analyse this phenomenon we compared the macroscopic and microscopic findings in 175 samples of endocardium from tissues presenting such haemorrhages of varying intensity: Only 8.6% showed a histological correlate and therefore could be verified as true haemorrhage. 53.7% presented mere hyperaemia and the remaining 37.7% even showed no microscopic finding at all. A satisfactory reason for this phenomenon could not be given by this investigation: The histological findings, however, do not depend on their cardial localization nor do they differ in relation to the cause of death or due to resuscitative actions. A possible cause of the described discrepancies may be a loss of haemoglobin of the erythrocytes. The results of this investigation point out that it might be necessary to reconsider the use of the term "subendocardial haemorrhage".

Cause of Death↗
PubMed1991

[Quantitative analysis of myocardial fibrosis in myocardial biopsies--a comparison between computer analysis and point counting method].

To select an appropriate method to analyze quantitatively myocardial fibrosis in myocardial biopsies, two methods, the computer analysis and the point-counting method observed at magnifications of x200 and x400, were compared. Our targeted points of examination were the accuracy and reproducibility of these methods. Twenty patients (10 with dilated cardiomyopathy and 10 with hypertrophic cardiomyopathy) were randomly selected, and the percent area of myocardial fibrosis in myocardial biopsies obtained from the right ventricular septum was measured by both the computer analysis and the point-counting method. Two observers measured the same area twice on the different days, independently. In the area of analysis, the endocardium was excluded to avoid the observer's bias. By comparing the data obtained from two observers, it was shown that the point-counting method tended to give a larger mean value and standard deviation than the computer analysis method, but that the latter indicated better reproducibility than the former. Our result showed that the degree of myocardial fibrosis varied according to methods of analysis and observer's experiences. It is recommended that the comparison of myocardial fibrosis should be made only when the methods of analysis of fibrosis are identical.

Cardiomyopathy, Dilated↗
PubMed1991

[A case of cardiomyopathy due to allergic bronchopulmonary aspergillosis].

We report a rare occurrence of cardiomyopathy associated with allergic bronchopulmonary aspergillosis (ABPA). A 49-year-old man with a history of bronchial asthma was referred to the Matsuyama Red Cross Hospital for evaluation of the abnormal shadow on his chest X-ray. Laboratory examination showed blood eosinophilia and marked elevation of serum IgE concentration and IgE antibody to A fumigatus. The immediate and late skin reactivities to A fumigatus antigen were both positive. The diagnosis of ABPA was made. Treatment using prednisolone was effective in ameliorating the symptoms. However, he was admitted again due to dyspnea, edema and anorexia 6 months later. Chest X-ray, ECG, UCG and scintigraphy suggested severe cardiac failure. The clinical diagnosis of hypertrophic cardiomyopathy, and the pathohistological diagnosis of endomyocardial fibrosis were made by cardiac catheterization and biopsy of endocardium. Retrospectively, cardiomegaly had gradually increased during the past several months while peripheral blood eosinophilia had continued. All these data strongly suggested that eosinophilia due to ABPA might cause severe cardiac damage.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1991

Transplacental cardiotoxicity of cocaine: atrial damage following treatment in early pregnancy.

Using light, transmission (TEM) and scanning (SEM) electron microscopy, cocaine-induced defects were observed in hamster atria. Compared with controls, the treated atria from neonates show endocardial and myocardial damages as the atrial walls thicken. SEM micrographs show intensive blebbing, damage and incomplete coverage of myocardium by the endocardial endothelium. TEM data demonstrate blebs, thinning, and other endothelial cell injuries and complement the SEM findings. Areas of endothelial sloughing may facilitate the formation of luminal and mural thrombi as noticed in many neonatal atria. Adjacent subendocardial myocardial cells display contraction bands, swellings, and vacuolizations. Local and large areas of damaged myocardial cells are observed in the subendothelial spaces; they contact fibroblasts squeezed or intercalated between the subendocardial spaces and the basal side of damaged endothelial cells. Many of these defects correspond to well-known ischemic changes. One can hypothesize that cocaine-induced defects appear to be linked to membranous alterations, including those associated with the endothelial cells of the endocardium.

Animals↗
PubMed1989

[Cardiac metastasis in primary cancer of the liver].

A rare case of a 77-year-old man with primary liver cancer and an isolated metastasis in the right atrial endocardium is presented. The metastasis was 30/40 mm large and occupied a considerable part of the atrial cavity. Clinically the disease was manifested by progressing chronic right ventricular failure, ending with a total heart failure. The diagnosis was made at the post mortem examination. The rarity of the case is pointed out. The possibility of a correct diagnosis while the patient was still alive is discussed.

Aged↗
PubMed1988

Endocardial control of myocardial performance.

Impairment of the endocardial surface has a profound influence on the mechanical performance of the underlying undamaged myocardium. It immediately and irreversibly shortens the duration of twitch tension development, particularly at a physiological extracellular [Ca++] and temperature, thereby affecting the relationship of peak isometric twitch tension development to both [Ca++]0 and length. Accordingly, the endocardium as the most primitive structure of the heart, may help to control the performance of the underlying myocardium by modulating the onset of early tension decline. These effects will result in important variations of peak contractile performance and of relaxation of the underlying myocardium.

Animals↗
PubMed1986

Endomyocardial biopsy site morphology. An experimental study in baboons.

Endomyocardial biopsy (EMB) is widely used, but the effects on the endocardium have not been studied in detail. If repetitive biopsies are performed, as in the monitoring of cardiac transplants, there is a chance of sampling a previous EMB site. This study investigates changes in EMB site morphology over a period of 0 to 30 days in a primate model. Organization of thrombus, necrosis of myocytes adjacent to the biopsy site, and the presence of mononuclear cells (including T lymphocytes) surrounding the biopsy site indicated a potential for confusion with the appearances associated with acute or resolving cardiac rejection. We have encountered this problem in clinical practice. Knowledge of EMB site morphology aids in the interpretation of EMB specimens.

Animals↗
PubMed1986

[Improved reproducibility of contrast echocardiography by SH U 454. Experimental studies using digital subtraction echocardiography].

The right heart chambers of 10 animals were contrasted by conventional (NaCl, CO2, H2O2, indocyanine green (ICG), haemaccel) and a newly developed echo-contrast medium (SH U 454) and studied by 2-D echocardiography. By means of digital subtraction echocardiography (DSE) endocardial borders were defined automatically and the results were compared with the manual input of endocardial borders of original and contrast echocardiograms. The area enclosed by these borders served as basis for the calculation of reproducibility (in %) and correlations. The following correlation coefficients (r) and SEE were calculated between the areas defined by the different contrast media and DSE and manually derived borders: r = 0.85, 3.98 cm2 (ICG), and 0.89, 1.00 cm2 (haemaccel). The best calculations were found using SH U 454 in concentrations between 100 and 300 mg/ml. The correlation coefficients were in the range of r = 0.95 and 0.98 with an SEE of 0.21 to 0.56 cm2 between manually and automatically derived contours. Comparing the reproducibility of data between the different evaluation methods we found the following results: manual input of endocardial borders in original echocardiograms 12.3%-16.9%; manual definition of endocardial borders in contrast echocardiograms 2.0% (SH U 454) - 15.7% (CO2); automatic contour finding in original echocardiograms 8.6%-28.9% (mean 21.6%); automatic definition of endocardium by DSE in contrast echocardiograms 7.6% (ICG) - 0.9% (SH U 454, 300 mg/ml). Our results demonstrate that digital subtraction echocardiography is a simple an safe procedure to define endocardial contours if echo contrast media lead to a uniform and homogeneous opacification of the left and right cardiac cavities.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Ultrastructural aspects of endomyocardial biopsy in restrictive cardiomyopathy: evaluation of elastogenesis.

Besides elastic and collagen fibres, numerous smooth muscle (SM) cells were found in the thickened endocardium in 3 cases of restrictive cardiomyopathy and in 1 case of congenital endocardial fibroelastosis. In 3 other cases of congenital endocardial fibroelastosis, fibroblast-like cells were present besides numerous fibres. The former seemed to originate from SM cells. The authors present their opinion that both in congenital and acquired endocardial fibroelastosis, the lesion develops essentially in the same way. The basic phenomenon consists in increased elastoplastic activity of SM cells. In contrast, the aetiology (stimulus) of higher, elastogenous activity of SM cells remains obscure and seems to be different in individual cases.

Adolescent↗
PubMed1985

[Automatic and semiautomatic contour finding of the left ventricle in the 2 dimensional echocardiogram. In vitro studies in formalin-fixed swine hearts].

In order to test semiautomatic and automatic contour finding procedures in 2-dimensional echocardiograms we determined endocardial borders in 42 short-axis slices of post-mortem animal hearts after interactive image enhancement such as scaling, normalisation and linearisation of grey levels semiautomatically and automatically by a complex contour finding algorithm. The areas calculated on the basis of these semiautomatic and automatic procedures were compared with "true" anatomic areas derived from planimetry. The complex computer algorithm is based on the detection and analysis of grey level gradients. The algorithm first creates a raw contour which still contains intra- and extracavitary artefacts as well as interrupted endocardial strings. Using a statistical iterative classification procedure and a least-square polynomial approximation the endocardial strings were structured, completed and smoothed and the artefacts eliminated. We were able to determine endocardial contours by semiautomatic methods in 33 (79%) and by automatic procedures in 30 (73%) of the echocardiograms. The correlation between semiautomatic and "true" contours was r = 0.97; y = 1.01x-0.46; standard error of the estimate (SEE) 0.51 cm2, between automatic and "true" contours r = 0.98; y = 0.99x - 0.31; SEE 0.43 cm2; the correlation parameters between the anatomic "true" areas and the areas calculated on the basis of manually derived borders were r = 0.98; y = 0.97x - 0.05; SEE 0.45 cm2. From our studies we conclude that left ventricular endocardium in short axis slices of postmortem animal hearts could reliably and reproducibly be detected by semiautomatic as well as by automatic procedures using a contour finding algorithm.

Animals↗
PubMed1985

Extended subendocardial resection. A surgical approach to ventricular tachyarrhythmias that cannot be mapped intraoperatively.

The optimal surgical management of patients with sustained, uniform-morphology ventricular tachycardia is endocardial activation sequence mapping during ventricular tachycardia and directed resection and/or cryoablation of the involved endocardium. The results of these procedures are superior to those obtained with nondirected aneurysmectomy. The optimal operative procedure when stable uniform ventricular tachycardia cannot be induced intraoperatively is uncertain. Between April, 1982, and April, 1984, intraoperative endocardial mapping was attempted on 33 patients with prior ventricular tachycardia. There were six perioperative deaths. Completely satisfactory intraoperative electrophysiologic maps were obtained in only 17 of the remaining 27 patients (63%). In 10 of these 27 patients, stable ventricular tachycardia could not be induced in the operating room, and satisfactory mapping thus could not be performed. In the first three of these 10 patients, limited subendocardial resection was performed either in regions with fractionated activity during sinus rhythm (two patients) or in regions suggested by preoperative catheter mapping (one patient). Ventricular tachycardia recurred postoperatively in two of these three patients. In the next seven patients, all visible endocardial scar around the border of the aneurysm was resected. Clinical ventricular tachycardia could not be induced at postoperative electrophysiologic study and has not recurred in these seven patients. These results suggest that complete endocardial resection provides an acceptable operative approach when intraoperative electrophysiologic mapping is not satisfactory.

Cardiac Catheterization↗
PubMed1985

[Automatic contour detection in the 2-dimensional echocardiogram--studies in a general patient population].

In order to test the application of an endocardial contour finding algorithm in apical projections we examined 56 consecutive patients by 2-D echocardiography. According to the quality of the endocardial definition we graded the total patient population in 4 qualities, grade I being the best and grade IV being the worst echocardiographic image with multiple extracavitary and intracavitary artefacts. Following manual and automatic detection of LV endocardium in end-systole and end-diastole by 2 observers we calculated LV areas (cm2), volumes (ml), ejection fraction (%) and regional wall motion (% radial shortening and % area shrinkage) and determined the reproducibility of the two different endocardial definitions. In all echocardiograms with good endocardial visualisation (grade I and II; n = 31, 55%), in 9 out of 15 patients with grade III and 4 out of 10 patients with grade IV echocardiograms we could successfully apply the contour finding algorithm. The comparison between automatically and manually detected contours showed good correlations with small standard errors; however the reproducibility of data expressed by the interobserver variability (V) calculated on the basis of automatically found contours was significantly better as compared to the manually derived contours. (V manual contour = 4.8-8.5 versus automatic contours 0.63-0.68). The systolic volumes (manual versus auto) correlated with r = 0.93, SEE 8.3 ml; the end-diastolic volumes (manual versus auto) with r = 0.90, SEE 11.3 ml, the ejection fraction (manual versus auto) with r = 0.93, SEE 5.1%. The determination of regional LV wall motion demonstrated an agreement in 91% and a discrepancy in 9% of regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1977

Histologic and ultrastructural features of primary and secondary endocardial fibroelastosis.

The average size of elastic fibers in thickened left ventricular endocardium was much larger in four patients with congenital endocardial fibroelastosis (EFE) than in six patients with acquired EFE (secondary to ischemic heart disease in two patients, to prosthetic cardiac valves in three, and to irradiation of the chest in one). Both components of normal elastic tissue (central, amorphous cores, and peripheral microfibrils) were present in endocardial elastic fibers of each patient. Ultrastructural identification of elastic fibers was greatly facilitated by staining with silver tetraphenylporphin sulfonate.

Adult↗
PubMed1979

Endocardial fibroelastosis found on transvascular endomyocardial biospsy in children.

Left ventricular endocardium obtained by transvascular endomyocardial biopsy from nine infants and children with various congestive cardiomyopathies showed thickening in five, with hyperplasia of endocardial cells and increase in elastic and collagen fibers (endocardial fibroelastosis). Based on the morphologic findings, we suggest a chronologic sequence of hyperplasia of smooth muscle (SM) cells followed by transformation and translocation. The sequence appears to be (1) proliferation of dark SM cells with many surface vesicles, many myofilaments, and fusiform densities; (2) possible proliferation of light SM cells containing fewer surface vesicles and fewer myofilaments than the dark SM cells; (3) transformation of SM cells to leiomyoid cells that resemble both SM cells and fibroblasts; and (4) transformation to typical fibroblasts. The cells producing the increased elastin and collagen are believed to be the SM cells and the leiomyoid cells.

Child, Preschool↗
PubMedDate not supplied

Protective effect of betamethasone on the subendocardial ischemia after the cardiopulmonary bypass.

The experimental and clinical studies on the protective effect of Betamethasone upon the myocardium particularly on the prevention of the subendocardial ischemia after the cardiopulmonary bypass was investigated on the ultrastructural alterations of the epicardium and the endocardium obtained by the transmural left ventricular myocardial biopsy. Pretreatment of Betamethasone, 5 mg/Kg, with single intravenous injection a half to one hour before cardiopulmonary bypass was effective to preserve the myocardial ultrastructure after the anoxic arrest and in the recovery period after restoring the coronary circulation. The intramyocardial gradient of the ultrastructure was diminished by Betamethasone hardly demonstrating the no-reflow phenomenon. Hemodynamic and metabolic changes did not show the significant effectiveness of Betamethasone. It was suspected that Betamethasone stabilized the cell membrane and lysosome and suppressed the interstitial edema in the myocardium during and after anoxic arrest.

Adult↗
PubMed1978

[Endomyocardial biopsy in the diagnosis of myocarditis and cardiomyopathies].

Fifty patients with the following suspected diseases were examined: examined: congenital heart disease (25), rheumatic heart disease (7), infectious-allergic myocarditis (12), fibroelastosis of the endocardium (3), alcoholic cardiomyopathy (2), drug cardiomyopathy (1). Catheterization biopsy of the endo- and myocardium was accomplished with a special bioptome after catheterization of the heart. No complications occurred during or after biopsy. The results of histologic and histochemical examination of the bioptates of the cardiac muscle are discussed. On the basis of the data in the literature and personal experience, it is concluded that biopsy of the endo- and myocardium may be undertaken to specify the etiology and pathogenesis of cardiomyopathy. The method is comparatively safe.

Adolescent↗