Inoue S, Shinohara F, Sakai T, Niitani H, Saito T, Hiromoto J, Otsuka T
Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.
Jpn Circ J. 1989 Jan;53(1):49-57. doi: 10.1253/jcj.53.49.
We studied the conduction system of 65 cases of proven active or healed myocarditis and related diseases among 7120 autopsy samples. For this purpose, we prepared serial sections by Lev's method. The pathological diagnoses were idiopathic acute myocarditis (5), giant cell myocarditis (3), chronic myocarditis (13), healed myocarditis (22), sarcoidosis (4), collagen or autoimmune disease (13) and complication of cachexia (5). Among all the autopsy cases, Fiedler's myocarditis was found in only one case, but myocarditis was revealed in 19 out of 30 cases of dilated cardiomyopathy, and 15 out of 25 cases of sick sinus syndrome. Conduction system lesions were divided into two groups. In older cases manifesting mainly arrhythmia, the SA node, atrial muscle and AV node were involved concomitantly with perimyocarditis. In younger cases mainly showing heart failure, the RBB, LBB and Purkinje fibers were damaged by endomyocarditis. Histologically, interstitial myocarditis was observed in the former group and parenchymatous myocarditis in the latter.
我们在7120份尸检样本中研究了65例经证实的活动性或愈合性心肌炎及相关疾病的传导系统。为此，我们采用列夫氏方法制备了连续切片。病理诊断为特发性急性心肌炎（5例）、巨细胞心肌炎（3例）、慢性心肌炎（13例）、愈合性心肌炎（22例）、结节病（4例）、胶原或自身免疫性疾病（13例）以及恶病质并发症（5例）。在所有尸检病例中，仅1例发现菲德勒氏心肌炎，但在30例扩张型心肌病中有19例发现心肌炎，在25例病态窦房结综合征中有15例发现心肌炎。传导系统病变分为两组。在以心律失常为主的老年病例中，窦房结、心房肌和房室结与心包炎同时受累。在以心力衰竭为主的年轻病例中，右束支、左束支和浦肯野纤维受心内膜炎损害。组织学上，前一组观察到间质性心肌炎，后一组观察到实质性心肌炎。
