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Pathology of cardiac transplantation

Open full size image General clinicopathologic considerations Cardiac transplantation is an accepted therapeutic option which provides long-term survival for many patients with end-stage heart failure. Over 140,000 heart transplants at over 400 centers worldwide were recorded by the International Society for Heart and Lung Transplantation (ISHLT) Registry between 1982 and 2017; approximately 4000 per year are presently done worldwide . The success of cardiac transplantation has…

Tumors of the cardiovascular system: heart and blood vessels

Open full size image Incidence and classification Cardiac tumors are rare and when they occur, they are most frequently benign. The autopsy incidence of primary cardiac tumors varies greatly by study with estimates ranging from 0.001% to 0.3% and a clinical prevalence of 0.001%–0.03% , of which 75% are benign and 25% malignant. Myxoma is the most common benign tumor (50%–70%) and angiosarcoma is the most…

The pathology of cardiovascular interventions and devices for coronary artery disease, vascular disease, heart failure, and arrhythmias

Central concept figure: comprehensive medical device pathology Introduction The last several decades have witnessed a virtual explosion in the armamentarium of interventional and surgical procedures and medical devices available to manage cardiovascular diseases. For example, percutaneous treatment of coronary artery disease is one of the most widely done medical procedures, with greater than one million procedures performed worldwide each year . In total, over five million…

Cardiac valve replacement and related interventions

Open full size image With a worldwide prevalence of over 100 million cases, valvular heart disease remains a significant human and clinical burden, necessitating over an estimated 400,000 interventions annually worldwide and estimated to surpass 850,000 by 2050 . Three factors account for this expected increase: (1) the most common type of valvular heart disease, aortic stenosis (AS) is strongly associated with aging, (2) with the…

Valvular heart disease

Open full size image Introduction Valvular heart disease (VHD) is the third most common cause of cardiovascular disease, responsible for significant morbidity and mortality at all ages. This chapter discusses the etiology, investigation, clinical manifestations, and complications of diseased native heart valves. It is to be noted that acquired valvular deformities most often involve the left-sided valves. The etiology of valvular disease varies in different parts…

The pericardium and its diseases

Open full size image Normal pericardium Structure Anatomy The pericardium is a bilayered sac-like structure surrounding the heart and the origin of the large blood vessels. The outer layer of this sac is called the parietal pericardium, which consists of an outer fibrous layer (fibrosa) and an inner layer of mesothelial cells called the serosal membrane or serosa. The pericardium does not have any direct attachment…

Cardiomyopathies

Open full size image Open full size image Open full size image Open full size image Definition and classification of cardiomyopathies The definition and classification of cardiomyopathies (CMPs) has been subject to revision for more than 30 years. In 1980, the World Health Organization/International Society and Federation of Cardiology (WHO/ISFC) defined primary CMPs as “heart muscle diseases of unknown cause” reflecting the general lack of knowledge…

Myocarditis

Open full size image Abbreviations ACE-I angiotensin converting enzyme inhibitors AIDS acquired immunodeficiency syndrome AKT an alternate name for protein kinase B AMR antibody-mediated rejection ARB angiotensin receptor blockers BNP brain natiuretic peptide CAR coxsackievirus and adenovirus receptor CMRI cardiac magnetic resonance imaging CMV cytomegalovirus COVID-19 coronavirus disease 2019 CRP C-reactive protein CT computed tomography CTC cell-mediated cytotoxicity CVB coxsackievirus serogroup B CXADR coxsackievirus and adenovirus…

Toxins and the heart

Open full size image Introduction Drug reactions are some of the most frequently encountered adverse complications in the hospital setting. As many as 30% of hospitalized patients may experience such a reaction, and an estimated one to two million Americans have a drug reaction each year. The presentation of adverse drug reactions is highly variable; one can occur with supratherapeutic/overdose levels, therapeutic doses, or even with…

Pathology of sudden death, cardiac arrhythmias, and conduction system

Open full size image (A) Arrhythmogenic cardiomyopathy: the arrhythmic killer is the fibrofatty replacement of the right ventricle (B) Hypertrophic cardiomyopathy: myocardial disarray is the substrate of the fatal tachyarrhythmia (C) The histology of coronary vasospasm: transient ST segment elevation, reperfusion, and onset of ventricular fibrillation Sudden death Introduction Sudden, unexpected death cuts short human life with cardiac arrest. It has been proven that electrical instability…

Myocardial ischemia and its complications

Open full size image Definition and history Ischemic myocardial injury may be defined simply as those changes that occur in the heart muscle as a result of an imbalance in oxygen and substrate supply and demand. The degree, time course, and type of injury depend on the severity and duration of the ischemic insult. When ischemia is of sufficient duration and magnitude, such that restitution of…

Aneurysms of the aorta: ascending, thoracic, and abdominal and their management

Open full size image Introduction Aortic aneurysms (AAs), either of the abdominal or thoracic aorta, are important causes of morbidity and mortality in developed countries. On the basis of autopsy studies, it has been estimated that 1%–2% of the population has AAs with up to 10% prevalence in older age groups . Ruptured abdominal aortic aneurysm (AAA) alone is responsible for 1%–2% of deaths in the…

Diseases of small and medium-sized blood vessels

Open full size image Introduction Vascular diseases encompass a multitude of disorders including inherited conditions, degenerative processes, trauma, inflammatory/autoimmune disorders, and infectious diseases. The disorders may primarily involve any layer of the vessel wall from the adventitia to the media to the intima, and even the blood in the lumen. While there are similarities in the pathologic changes of many vascular diseases, there are also many…

Vascular Pathobiology: Atherosclerosis and Large Vessel Disease

Open full size image Introduction to atherosclerosis Atherosclerosis is a leading cause of morbidity and mortality in North America and results in major economic and health burdens across the globe . Atherosclerosis is a chronic vascular disease initially involving the intima of elastic and larger muscular arteries and characterized by the presence of fibroinflammatory lipid plaques (atheromas). The name of the plaque reflects the main cellular…

Congenital heart disease: pathology, natural history, and interventions

Open full size image Abbreviations CHD Congenital Heart Disease; AS Aortic valve Stenosis; ASD Atrial Septal Defect; AVSD AtrioVentricular Septal Defect; CoA Coarctation of the Aorta; DILV Double Inlet Left Ventricle; DOLV Double Outlet Left Ventricle; DORV Double Outlet Right Ventricle; d -TGA d extro-Transposition of the Great Arteries; FGF Fibroblast Growth Factor; FHF First Heart Field HLHS Hypoplastic Left Heart Syndrome; l -TGA l evo-Transposition…

Pathophysiology of heart failure and an overview of therapies

Open full size image Overview of heart failure Definition of heart failure and general features of the condition Heart failure (HF) is formally defined as a complex clinical syndrome resulting from any structural and/or functional impairment of ventricular filling or ejection. This somewhat broad definition is necessary as HF represents the final common pathway of disparate cardiovascular pathologies that lead to an insufficient supply of oxygen…

Fundamental principles in cardiovascular genetics

Open full size image Central concept figure The cardiovascular system can be impacted by a number of different genetic diseases (inner ring). There are numerous types of alterations to the human genome associated with these diseases (outer ring). The techniques to identify genetic variation associated with disease in a given patient continue to grow, but often rely on fundamental principles of molecular genetics (middle ring). Please…

Age-related cardiovascular changes and diseases

Open full size image Open full size image Introduction Longevity is increasing and the population of older adults is expanding . In Europe, the estimated percentage of the elderly population (aged older than 65 years) is 16.1% . In Japan, the elderly population is expected to exceed 30% in 2025 . Elderly people require dedicated therapeutic approaches because medical care for this population is different from…

Anatomic considerations and examination of cardiovascular specimens (excluding devices)

Open full size image Open full size image Open full size image Cardiac and vascular gross and microscopic anatomy has been appreciated for many years. Knowledge of ultrastructural anatomy and physiology followed. Disease was noted long before pathogenesis was clarified and it is humbling to realize that this is still so. We continue to learn about both normal and abnormal heart function. Cardiac specimens were originally…

Cardiovascular pathology: guide to practice and training

Open full size image Introduction Cardiovascular pathology is focused on diseases of the heart and blood vessels. Cardiovascular pathology is practiced as a subspecialty primarily in academic health centers and other referral centers, particularly those with heart transplant programs, and also in forensic pathology facilities . Because of the specialized practice venues, cardiovascular pathologists constitute a smaller subspecialty group compared to other pathology subspecialties. However, the…