Slootweg P J, Schuurman H J, Jambroes G
Department of Internal Medicine, University Hospital, Utrecht, The Netherlands.
J Heart Transplant. 1989 Nov-Dec;8(6):450-3.
Vascular pathologic lesions are a severe and irreversible complication of allogeneic heart transplantation despite immunoprophylactic treatment. These vascular alterations may be characterized by a lymphocytic vasculitis or lumen occlusion by proliferative vasculopathy (or both). They are not readily detected by endomyocardial biopsy. We describe a patient who expired 21 weeks after orthotopic heart transplantation. Graft failure was caused by extensive vascular changes of both an infiltrative and a proliferative nature with subsequent ischemic damage to the myocardium. Vacuolated myocytes observed in the last biopsy specimen obtained before death appeared at postmortem investigation to represent a subendocardial strip of sublethally injured myocytes. Because ischemic damage as a result of vascular rejection may involve a much larger area of the myocardium than the diseased vessel itself, subendocardial myocytic vacuolation in the biopsy specimen may be a valuable diagnostic sign indicating vasculopathy in the graft.
尽管进行了免疫预防治疗，但血管病理损伤仍是同种异体心脏移植的一种严重且不可逆的并发症。这些血管改变的特征可能是淋巴细胞性血管炎或增殖性血管病变导致的管腔闭塞（或两者皆有）。心内膜心肌活检不易检测到这些病变。我们描述了一名在原位心脏移植术后21周死亡的患者。移植物衰竭是由浸润性和增殖性的广泛血管变化以及随后的心肌缺血损伤引起的。在死亡前获取的最后一份活检标本中观察到的空泡化心肌细胞，在尸检时发现代表了一条心内膜下带，其中是亚致死性损伤的心肌细胞。由于血管排斥导致的缺血损伤可能累及的心肌面积比病变血管本身大得多，因此活检标本中的心内膜下心肌细胞空泡化可能是提示移植物血管病变的一个有价值的诊断标志。
