Pichler Sekulic Simona, Sekulic Miroslav
Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, United States.
Front Cardiovasc Med. 2021 Mar 10;8:621632. doi: 10.3389/fcvm.2021.621632. eCollection 2021.
Thrombotic angiopathy is a pathologic description to describe endothelial injury, and with sufficient and sustained injury can lead to exposure of underlying tissue factor and the deposition of associated fibrin material. We present briefly a case of an 87-year-old woman with mitral valve regurgitation and atrial fibrillation undergoing mitral valve annuloplasty, Cox-maze procedure, and excision of the left atrial appendage. Pathologic examination of the excised atrial appendage revealed commonly encountered cardiomyocyte hypertrophy and endocardial fibroelastosis, however also showed a non-occlusive, acute thrombotic angiopathy involving epicardial veins. The surgical and immediate post-operative course was unremarkable; however, 3 weeks after discharge, the patient would develop a fatal pulmonary embolism. While fibrin thrombosis developing within the atrial appendage chamber is a recognized concern in the setting of atrial fibrillation, the significance of an acute thrombotic angiopathy involving epicardial veins of the atrial appendage is less clear although in the presented case was the sole potential harbinger of a subsequent fatal thrombotic event.
血栓性血管病是一种描述内皮损伤的病理学表述，当损伤足够严重且持续存在时，可导致潜在组织因子的暴露及相关纤维蛋白物质的沉积。我们简要介绍一例87岁患有二尖瓣反流和心房颤动的女性患者，她接受了二尖瓣环成形术、Cox迷宫手术以及左心耳切除术。对切除的心耳进行病理检查，发现常见的心肌细胞肥大和心内膜纤维弹性组织增生，但也显示出累及心外膜静脉的非闭塞性急性血栓性血管病。手术及术后即刻过程顺利；然而，出院3周后，患者发生致命性肺栓塞。虽然在心耳腔内形成纤维蛋白血栓是心房颤动情况下公认的问题，但累及心耳心外膜静脉的急性血栓性血管病的意义尚不清楚，尽管在本病例中它是随后致命血栓事件的唯一潜在预兆。
