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Histopathology of Resected Myocardium and Outcome of Partial Left Ventriculectomy
Author(s) -
Kawaguchi Akira T.,
IshibashiUsda Hatsue,
Bergsland Jacob,
Karamanoukian Hratch L.,
Koide Shirosaku,
Batista Randas J.V.
Publication year - 2001
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2001.tb00484.x
Subject(s) - medicine , histopathology , fibrosis , cardiology , muscle hypertrophy , pathology , mononuclear cell infiltration , transplantation , gastroenterology
A bstractBackground: Since preoperative hemodynamics are not proven to be a predictor of effects of partial left ventriculectomy (PLV), myocardial histopathology may be better correlated with effects and outcome of PLV. Methods: Myocyte size (μ) in the excised myocardium was measured in 338 patients undergoing PLV. Endocardial fibrosis, interstitial fibrosis, and inflammatory cell infiltration were enumerated as none = 0, mild = 1, moderate = 2, and severe = 3. These histopethologic observations were correlated with patients' postoperative survival. Results: Reduced survival was seen in patients with advanced (≥ moderate) interstitial fibrosis in all patients (n = 338, p = 0.064) and in the subgroup with nonischemic etiology (n = 229, p = 0.0039). Although correlation between endocardial and interstitial fibrosis was significant (r = 0.55, p < 0.01), endocardial fibrosis failed to correlate with postoperative survival. While Chagas' disease was associated with severe inflammation and poor survival, the presence of inflammatory cell infiltration had no effect on survival in all patients combined (p = 0.943). Although most patients (n = 266, 79%) had myocyte diameter over 30 μ, those with less hypertrophy (> 30 μ, n = 70, 21%) had a tendency toward increased survival (p = 0.067) regardless of underlying etiology. Conclusion: Interstitial fibrosis may be an important factor in stratification of patients for repair (PLV) or replacement (transplantation). PLV may be more beneficial in patients with less hypertrophy, before development of interstitial fibrosis. Endomyocardial biopsy might not predict the extent or variation in degree of interstitial fibrosis, which may be better evaluated by other metabolic or perfusion studies that measure overall myocardial histopathology and viability.