The myocardial lesions by the injections of isologous heart emulsion were produced in rabbits, and organspecific isoimmune mechanism in the genesis of myocardial lesions was studied by fluorescent antibody technique and demonstration of antibodies against isologous heart muslce. Four groups of rabbits were subjected to normal untreated control, adjuvant control, injection of isologous heart homogenate aIone and injection of heart homogenate plus Freund's adjuvant. Injection of isologous heart homogenate produced circulating anti-heart muscle antibodies which were enhanced by addition of Freund's adjuvant in heart homogenate. Histologic lesions in the heart consisted of interstitial edema, mononuclear cell infiltration, degeneration of myofibers and stromal reaction. Fluorescent antibody technique on myocardial lesions showed presence of anti-heart antibodies in parallel with the degree of myocardial lesions as well as with titre of circulating antibodies. Skeletal muscle and other organs showed neither histologic alteration nor precence of anti-heart antibodies. These data clear1y indicated that the lesion in the myocardium produced by isologous heart homogenate was developed by organ-specific isoimmune reaction.
Animals ; Autoimmune Diseases/*pathology ; Fluorescent Antibody Technique ; Myocarditis/*pathology ; Rabbits

BACKGROUNDMyocarditis is a common, potentially life-threatening disease that presents a wide rang of symptoms in children, as an important underlying etiology of other myocardial diseases such as dilated and arrhythmogenic right ventricular cardiomyopathy. The incidence of nonfatal myocarditis is probably greater than that of the one actually diagnosed, which is the result of the challenges of establishing the diagnosis in standard clinical settings. Currently, no single clinical or imaging finding confirms the diagnosis of myocarditis with absolute certainty. Historically, clinical exam, electrocardiogram (ECG), serology and echocardiography had an unsatisfactory diagnostic accuracy in myocarditis. Endomyocardial biopsy remains as a widely accepted standard, but may not be suitable for every patient, especially for those with less severe disease. Our aim was to find the changes in cardiovascular magnetic resonance (CMR) imaging of children with myocarditis diagnosed by clinical criteria.

METHODSWe studied 25 children (18 male, 7 female; aged from 5-17 years) with diagnosed myocarditis by clinical criteria. CMR included function analyses, T2-weighted imaging, T1-weighted imaging before and after i.v. gadolinium injection (early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE)).

RESULTSThe T2 ratio was elevated in 21 children (84%, 11 in anterolateral (44%), 5 in inferolateral (20%), and 5 in septum (20%)), EGE was present in 9 children (36%, 3 in anterolateral (12%), 4 in inferolateral (20%), and 2 in septum (8%)), and LGE was present in 5 children (20%, 2 in anterolateral (8%), 1 in inferolateral (4%), 1 in septum (4%), and 1 in midwall of left ventricular (LV) wall). In 9 children (36%), two (or more) out of three sequences (T2, EGE, LGE) were abnormal.

CONCLUSIONSThe CMR findings in children with clinically diagnosed myocarditis vary within the groups, including regional or global myocardial signal increase in T2-weighted images, EGE and LGE in T1-weighted images. The T2 ratio elevation is the most common CMR finding. Children with mild cardiac symptoms may also appear serious myocardial injuries.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Myocarditis ; pathology ; Myocardium ; pathology

Acute Disease ; Adult ; Cholecystitis, Acute ; diagnosis ; pathology ; Diagnostic Errors ; Female ; Humans ; Myocarditis ; diagnosis ; pathology

OBJECTIVE: To study the value of Fibronectin(Fn) immunohistochemical staining for diagnosing slight viral myocarditis. METHODS: The heart samples of human with myocarditis were studied by using LSAB immunohistochemical staining with anti-fibronectin antibody. RESULTS: Dense deposition was found in the myocardium of human with myocarditis. Some Fn-positive cardiomyocytes were observed. CONCLUSION Slight degeneration of cardiomyocytes could be identified by Fn-LSAB immunohistochemical staining and Fn-deposition is one of the reliable marks for inflammation in the myocardium.
Autopsy ; Death, Sudden/pathology* ; Diagnosis, Differential ; Fibronectins/metabolism* ; Humans ; Immunohistochemistry ; Myocarditis/virology* ; Myocardium/pathology* ; Staining and Labeling

Eosinophilic myocarditis is a disease characterized by eosinophilic infiltration of the myocardium, consisting of acute necrotic stage, thrombotic stage, and fibrotic stage. Although T1 mapping has been increasingly used in various cardiac pathologies, there has been no report of T1 mapping in eosinophilic myocarditis. We report a case of 75-year-old female with eosinophilic myocarditis, whose cardiac magnetic resonance imaging included native T1 mapping, in which apical thrombi were distinctly seen as areas with decreased T1 values, next to areas of inflammation seen as increased T1 value in subendocardium.
Aged ; Churg-Strauss Syndrome* ; Eosinophils* ; Female ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Myocarditis* ; Myocardium ; Necrosis ; Pathology ; Thrombosis

To study the diagnostic method of slight viral myocarditis in the field of forensic pathology, slight viral myocarditis model was induced in Balb/c murine by coxsackie virus B3. Organs of hearts, livers, spleens, lungs and kidneys were examined through routine pathological methods. Pathological changes at different levels of these organs were observed. The results indicated that viral myocarditis was a kind of disease with multiple organ alterations and that the pathological observation and comprehensive analysis of multiple organs was one of the useful methods for diagnosing slight viral myocarditis.
Animals ; Coxsackievirus Infections/pathology* ; Female ; Forensic Medicine ; Male ; Mice ; Mice, Inbred BALB C ; Myocarditis/virology*

OBJECTIVE: To study the pathogenesis of viral myocarditis (VMC) and dilated cardiomyopathy (DCM) and their relationship. METHODS: Sixty samples including 20 VMC, 20 DCM and 20 controls were collected. The expression of Fas protein in myocardium of each group was detected by modified immunohistochemistry with unequivocal brown staining in the myocardial membrane scored as positive, and the results of positive reaction were analyzed by Ridit test. RESULTS: Fas protein expression increased obviously in VMC and DCM groups as compared with that of the control group. The difference of positive results between each group analyzed by Ridit test was statistically significant (P<0.005). Statistically significant differences were found between VMC and control groups as well as between DCM and control groups (P<0.05), but not between VMC and DCM groups (P>0.05) by multiple comparison Ridit test. CONCLUSION The expression of Fas protein is significantly higher in the VMC and DCM groups than in that of the control group. These results suggest that both the VMC and DCM may share a similar pathogenesis, which most likely involves cell apoptosis.
Apoptosis/physiology* ; Cardiomyopathy, Dilated/pathology* ; Case-Control Studies ; Female ; Forensic Pathology ; Humans ; Male ; Myocarditis/virology* ; fas Receptor/metabolism*

OBJECTIVETo identify clinical and pathological features of giant cell myocarditis.

METHODSClinical presentation and follow-up data of three patients with giant cell myocarditis were collected.Gross, histopathological, immunohistological and ultrastructural findings of extransplantated hearts of the patients were documented.

RESULTSGrossly, multifocal involvement of the myocardium with variably dilated cardiac chambers were observed in all 3 cases.Histological examination revealed pronounced focal inflammatory infiltrates with multinucleated giant cells. Multinucleated giant cells were positive for CD68 and CD11b immunostains but were negative for CD163 in all cases. Transmission electron microscopy showed that the multinucleated giant cells derived from fusion of several macrophages with adherent lymphocytes and secretary cells. Clinically, the overall patient condition improved in all three cases after heart transplantation.One patient experienced acute cellular rejection (2R level) 4 months after transplantation, but recovered after treatment. One patient developed multinucleated giant cells observed in heart biopsy two weeks after transplantation.

CONCLUSIONSGiant-cell myocarditis is a rare disease of adult, and cardiac transplantation could improve the clinical outcome. Multinucleated giant cell in the myocarditis lesions were derived from macrophages, likely participating in the immune response. Endomyocardial biopsy is important for the diagnosis of giant cell myocarditis.

Acute Disease ; Adult ; Biopsy ; Giant Cells ; pathology ; ultrastructure ; Heart Transplantation ; Humans ; Lymphocytes ; pathology ; Macrophages ; pathology ; Microscopy, Electron, Transmission ; Myocarditis ; pathology ; Myocardium ; pathology ; ultrastructure

OBJECTIVESTo study the pathologic feature of sudden cardiac death in Yunnan province and to investigate the role of myocarditis.

METHODSDuring the period from 1991 to 2006, there were 29 cases of sudden cardiac death with autopsy performed. Fourteen of these cases were diagnosed to have myocarditis based on Dallas criteria and World Heart Federation's consensus. The clinical and pathologic findings were reviewed. The cardiac conduction system was examined in details by serial sectioning in 3 cases.

RESULTSFourteen cases suffered with myocarditis, which accounted for 48% of all cases of sudden cardiac death studied. The age of the deceased ranged from 8 to 68 years (mean = 30 years), with male-to-female ratio equaled to 9:5. Lymphocytic myocarditis and neutrophil myocarditis were the two major types, affecting 11 and 3 cases, respectively. The inflammatory infiltrates were often patchy rather than diffuse. The inflammatory foci were detected only in 8% to 42% (average = 20%) of the paraffin sections of the heart tissue. These lesions were usually located in the lateral wall of left ventricle and occasionally in interventricular septum and right ventricular wall. Myocardial injury was mild in most cases while patchy myocytolysis or coagulation necrosis was observed only in a few cases. Most of the lesions were relatively new and histologic evidence of myocardial repairing sometimes coexisted. Pericarditis and subacute endocarditis were also identified in 4 and 1 cases, respectively. Atrioventricular node was involved by myocarditis in 1 of the 3 cases examined for cardiac conduction system. Two cases showed gross evidence of cardiac dilatation (either left ventricle or biventricular). Respiratory tract and pulmonary infection was present in 5 cases.

CONCLUSIONSMyocarditis represents one of the major pathologic changes of sudden cardiac death occurring in Yunnan province. The inflammation is usually focal. Further studies are required for delineation of possible etiologies which may include virus, bacteria or exogenous toxin.

Adolescent ; Adult ; Aged ; Atrioventricular Node ; pathology ; Child ; China ; epidemiology ; Death, Sudden, Cardiac ; epidemiology ; pathology ; Dilatation, Pathologic ; pathology ; Endocarditis ; pathology ; Female ; Humans ; Inflammation ; pathology ; Lymphocytes ; pathology ; Male ; Middle Aged ; Myocarditis ; diagnosis ; epidemiology ; mortality ; pathology ; Myocardium ; pathology ; Pericarditis ; pathology

Pericarditis and myocarditis are characterised by electrocardiographic changes and elevated cardiac enzymes, respectively, and patients with perimyocarditis often complain of chest discomfort. These findings are nonspecific and often lead to diagnostic difficulties, as ST-elevation myocardial infarction commonly presents in a similar fashion. Clinical differentiation between perimyocarditis and myocardial infarction are especially important because adverse side effects can occur if reperfusion therapy is administered for a patient with acute pericarditis or if a diagnosis of acute myocardial infarction is missed. We herein describe a case of perimyocarditis with ST elevation and raised cardiac markers, which led to two emergency coronary angiographies that were subsequently found to be normal. We include the three serial electrocardiographies (ECGs) performed to show the characteristic features of perimyocarditis and further discuss the importance of identifying typical and atypical ECG features of pericarditis.
Acute Disease ; Aged ; Biopsy ; Blood Pressure ; Coronary Angiography ; Electrocardiography ; Female ; Humans ; Myocardial Infarction ; pathology ; Myocarditis ; diagnosis ; physiopathology