Huntrakoon M, Gollub S B
Department of Pathology and Oncology, University of Kansas Medical Center, Kansas City.
Am J Cardiovasc Pathol. 1988;2(1):91-6.
Chronic rejection is characterized by obliterative arteritis of coronary arteries and their branches in the form of myointimal proliferation and diffuse tubular atherosclerosis. Chronic rejection is more difficult to detect than discrete focal obstructive lesions by coronary angiography. We report a case of a 51-year-old woman in whom a biopsy of the right ventricle 14 months after heart transplantation revealed convincing histologic evidence of chronic rejection. A subsequent biopsy of the left ventricle showed subendocardial infarct. Necropsy findings confirmed coronary artery changes of chronic rejection, as well as diffuse subendocardial infarction, which had been suspected clinically. The finding of a small arteriole in a biopsy was fortuitous. However, if such a vessel is present and shows obliterative arteritis, this demonstrates that a premortem histologic diagnosis of chronic rejection is possible.
慢性排斥反应的特征是冠状动脉及其分支出现闭塞性动脉炎，表现为肌内膜增生和弥漫性管状动脉粥样硬化。与冠状动脉造影显示的离散局灶性阻塞性病变相比，慢性排斥反应更难检测。我们报告一例51岁女性病例，心脏移植14个月后右心室活检显示有令人信服的慢性排斥反应组织学证据。随后左心室活检显示心内膜下梗死。尸检结果证实了临床上怀疑的慢性排斥反应的冠状动脉改变以及弥漫性心内膜下梗死。活检中发现一条小动脉是偶然的。然而，如果存在这样的血管并显示闭塞性动脉炎，这表明生前对慢性排斥反应进行组织学诊断是可能的。
