Mozaffari Kambiz, Bakhshandeh Hooman, Amin Ahmad, Naderi Nasim, Taghavi Sepideh, Ojaghi-Haghighi Zahra, Abdollahi Mahsa
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Res Cardiovasc Med. 2014 Feb;3(1):e13986. doi: 10.5812/cardiovascmed.13986. Epub 2014 Feb 24.
The current trend of heart transplantation in recent years has taken a quantum leap forward. We decided to look back at our experience in this center.
Here, we focus on the diagnostic pitfalls and challenges in these biopsies.
Forty two patients based on the standard protocol of heart transplantation group, yielded 63 biopsy samples over a period of 33 months (April 2010 - December 2012). The mean age was 30.4 years (ranging from 16 to 58 years) with 51 males (81%) and 12 females (19%). All the patients were examined periodically and biopsy samples were taken from the right ventricular wall.
Rarely fewer than three pieces of myocardial samples were procured. Scar, adipose tissues and blood clots may be seen instead. Quilty effect (nodular endocardial lesions composed of inflammatory cell infiltrates) was seen in 8 cases (12.7%). Other findings not directly related to rejection including early ischemic injury, Quilty effect and post-transplant lymphoproliferative disorders (PTLD) were not encountered.
Specimen inadequacy was not a major problem in our center. It poses a great limitation, because suboptimal specimens sometimes mislead the pathologist. Other findings especially Quilty effect were within the range defined for this finding.
近年来心脏移植的当前趋势有了巨大飞跃。我们决定回顾本中心在这方面的经验。
在此，我们关注这些活检中的诊断陷阱和挑战。
按照心脏移植组的标准方案，42例患者在33个月（2010年4月至2012年12月）期间获得了63份活检样本。平均年龄为30.4岁（范围为16至58岁），其中男性51例（81%），女性12例（19%）。所有患者均定期接受检查，活检样本取自右心室壁。
很少能获取少于三块的心肌样本。反而可能会看到瘢痕、脂肪组织和血凝块。8例（12.7%）出现了奎尔蒂效应（由炎性细胞浸润组成的结节性心内膜病变）。未遇到其他与排斥反应无直接关系的发现，包括早期缺血性损伤、奎尔蒂效应和移植后淋巴细胞增生性疾病（PTLD）。
在我们中心，样本不足并非主要问题。它构成了一个很大的限制，因为欠佳的样本有时会误导病理学家。其他发现，尤其是奎尔蒂效应，在该发现所定义的范围内。
