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肥厚性梗阻性心肌病的尸体解剖评估

A Cadaveric Evaluation of Hypertrophic Obstructive Cardiomyopathy.

作者信息

Murtha Celeste M, Dobson John R, Olinger Anthony B

机构信息

Anatomy, College of Osteopathic Medicine, Kansas City University, Kansas City, USA.

Pathology and Anatomical Sciences, College of Osteopathic Medicine, Kansas City University, Kansas City, USA.

出版信息

Cureus. 2023 Jun 23;15(6):e40870. doi: 10.7759/cureus.40870. eCollection 2023 Jun.

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) describes a pathologic state in which the subaortic region of the interventricular septum undergoes significant hypertrophy and fibrosis, resulting in septal bowing into the left ventricle. The reduced left ventricular chamber size and altered cardiac function impair diastolic filling, stroke volume, and cardiac output. This case report evaluates the cardiac tissue of a 36-year-old, formalin-embalmed cadaver affected by HOCM, with the goal of providing a comprehensive overview of the gross and pathologic findings associated with the condition. This donor's heart was found to be larger than average, weighing 510.1 g, which is 52% heavier than the predicted value of 335.6 g for a male of similar stature. The thickness of the interventricular septum, right ventricular free wall, and left ventricular free wall was comparable to other reports of HOCM. However, asymmetrical thickening of the left ventricular walls, which is characteristic of HOCM, was less prominent than expected. Histologic staining of the cadaveric tissue, with hematoxylin and eosin, trichrome, and desmin, further bolstered the diagnosis. Importantly, this also showed that histologic examination of embalmed tissue is effective and diagnostic, even 11 months after embalming. The report herein demonstrates that morphologic and histologic analysis of cadaveric cardiac tissue is sufficient to support a diagnosis of HOCM. To the researchers' knowledge, this is the first case report evaluating HOCM in a cadaver donated for medical education.

摘要

肥厚型梗阻性心肌病(HOCM)描述了一种病理状态,即室间隔的主动脉下区域发生显著肥厚和纤维化,导致室间隔向左心室凸出。左心室腔大小减小和心功能改变会损害舒张期充盈、每搏输出量和心输出量。本病例报告评估了一名36岁、经福尔马林防腐处理的受HOCM影响的尸体的心脏组织,目的是全面概述与该疾病相关的大体和病理发现。发现该供体心脏大于平均水平,重510.1克,比身高相似男性的预测值335.6克重52%。室间隔、右心室游离壁和左心室游离壁的厚度与其他HOCM报告相当。然而,HOCM的特征性表现——左心室壁不对称增厚,不如预期明显。对尸体组织进行苏木精-伊红染色、三色染色和结蛋白染色,进一步支持了诊断。重要的是,这也表明,即使在防腐处理11个月后,对防腐组织进行组织学检查也是有效且具有诊断意义的。本文报告表明,对尸体心脏组织进行形态学和组织学分析足以支持HOCM的诊断。据研究人员所知,这是第一份评估用于医学教育捐赠尸体中HOCM的病例报告。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/43ed/10363410/4c4055ab7830/cureus-0015-00000040870-i01.jpg

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