[Clinicopathologic analysis of dilated heart in cardiac transplant recipients].

OBJECTIVE: To study the pathologic features of dilated heart in cardiac transplant recipients, with clinicoradiologic correlation. METHODS: Sixty recipient hearts from cardiac transplantation performed in Fuwai Hospital were analyzed by gross examination, histologic observation and electron microscopy. Clinicoradiologic correlation was available in 40 cases. RESULTS: Amongst the 40 cases of dilated heart, 52.5% (21/40) were due to dilated cardiomyopathy, 22.5% (9/40) due to arrhythmogenic right ventricular cardiomyopathy, 15.0% (6/40) due to ischemic cardiomyopathy, and the remaining 10.0% (4/40) due to miscellaneous causes, including local noncompaction of ventricular myocardium, giant cell myocarditis, alcoholic cardiomyopathy and hypertensive cardiomyopathy. The discrepancy rate between clinical and pathologic diagnosis was 37.5% (15/40). The erroneous categories included arrhythmogenic right ventricular cardiomyopathy (7 cases), ischemic cardiomyopathy (5 cases), and giant cell myocarditis (1 case), which were all mistaken clinically as dilated cardiomyopathy. While ischemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, noncompaction of ventricular myocardium and giant cell myocarditis have distinctive pathologic features, the diagnosis of alcoholic and hypertensive cardiomyopathies required clinicopathologic correlation. Dilated cardiomyopathy due to viral myocarditis was not identified in the cases studied. CONCLUSION: Pathologic examination is essential in analysis of transplant recipient heart and helps to rectify clinical diagnostic discrepancy.

[Clinical-pathological study on 10 cases of pulmonary thromboembolism].

OBJECTIVE: To improve the diagnosis of pulmonary thromboembolism (PTE) by a clinical-pathological analysis of 10 cases of PTE. METHODS: Eight cases of massive and submassive (in the segmental and larger pulmonary arteries) PTE confirmed by autopsy and 2 cases of PTE who underwent surgical treatment in the past 10 years (1991 - 2001) were studied. The specimens were fixed in 10% buffered formalin, and paraffin sections cut, and stained with HE and ET + VG. The pathological features were analyzed. RESULTS: There were 8 males and 2 females, aged 3.5 to 72 years (mean 33.3). The underlining diseases included congenital heart diseases (3 cases of ventricular septal defect complicated with pulmonary hypertension, and 1 case of tetralogy of Fallot), malignant lymphoma in the heart (n = 1), rheumatic heart disease (n = 1), lung metastatic cancer from stomach (n = 1), and phlebitis of the legs (n = 1). The sources of PE remained unknown in 2 cases. Among these cases, only 2 were diagnosed clinically. CONCLUSIONS: The research showed that PTE in patients who had underlining cardiovascular diseases, malignant tumors in the heart or lungs and pneumonia (pulmonary abscess) were hard to diagnose clinically. Pathological study is helpful in improving the clinical diagnosis of PTE.