Premortem histologic evidence of chronic vascular rejection obtained from percutaneous endomyocardial biopsy: report of a case.

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.