Adult ; Aneurysm, False ; diagnostic imaging ; surgery ; Anti-Bacterial Agents ; therapeutic use ; Echocardiography, Transesophageal ; Endocarditis, Bacterial ; diagnostic imaging ; drug therapy ; Female ; Heart Valve Prosthesis Implantation ; Heart Ventricles ; pathology ; Humans ; Mitral Valve ; surgery ; Mitral Valve Insufficiency ; diagnostic imaging ; surgery

Adult ; Aneurysm, Dissecting ; diagnosis ; etiology ; Computed Tomography Angiography ; methods ; Conservative Treatment ; methods ; Coronary Angiography ; methods ; Coronary Vessels ; diagnostic imaging ; pathology ; Electrocardiography ; methods ; Heart Injuries ; complications ; Humans ; Magnetic Resonance Imaging, Cine ; methods ; Male ; Multimodal Imaging ; methods ; Myocardial Infarction ; diagnosis ; etiology ; therapy ; Treatment Outcome ; Wounds, Nonpenetrating ; complications

OBJECTIVE: To analyze the morphological features and forensic pathological characteristics of cardiac ruptures of different causes for their differential diagnosis. METHODS: We analyzed the data of 44 autopsy cases of cardiac rupture from 2014 to 2017 in our institute, including 11 cases caused by blunt violence with intact pericardium, 4 caused by cardiopulmonary resuscitation (CPR), 9 by myocardial infarction, and 20 by aorta dissection rupture.The gross features and histopathological characteristics of cardiac rupture and pericardial effusion were analyzed and compared. RESULTS: Cardiac ruptures caused by blunt violence varied in both morphology and locations, and multiple ruptures could be found, often accompanied with rib or sternum fractures; the volume of pericardial effusion was variable in a wide range; microscopically, hemorrhage and contraction band necrosis could be observed in the cardiac tissue surrounding the rupture.Cardiac ruptures caused by CPR occurred typically near the apex of the right ventricular anterior wall, and the laceration was often parallel to the interventricular septum with frequent rib and sternum fractures; the volume of pericardial blood was small without blood clots; microscopic examination only revealed a few hemorrhages around the ruptured cardiac muscular fibers.Cardiac ruptures due to myocardial infarction caused massive pericardial blood with blood clots, and the blood volume was significantly greater than that found in cases of CPR-induced cardiac rupture ( < 0.05);lacerations were confined in the left ventricular anterior wall, and the microscopic findings included myocardial necrosis, inflammatory cell infiltration, and mural thrombus.Cardiac tamponade resulting from aorta dissection rupture was featured by massive pericardial blood with blood clots, and the blood volume was much greater than that in cases of cardiac ruptures caused by blunt violence, myocardial infarction and CPR ( < 0.05). CONCLUSIONS Hemorrhage, inflammatory cell infiltration, and lateral thrombi around the cardiac rupture, along with pericardial blood clots, are all evidences of antemortem injuries.
Aneurysm, Dissecting ; complications ; Aortic Aneurysm ; complications ; Cardiopulmonary Resuscitation ; adverse effects ; Forensic Pathology ; Heart Rupture ; etiology ; pathology ; Heart Rupture, Post-Infarction ; pathology ; Humans ; Myocardial Contusions ; complications

Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intra-operative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.
Academic Medical Centers ; Aneurysm, False ; Causality ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria ; Heart Diseases ; Heart Neoplasms* ; Heart Transplantation ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mitral Valve ; Pathology ; Thrombosis* ; Unconsciousness

Aged ; Coronary Angiography ; Endocardium ; pathology ; Heart Aneurysm ; diagnosis ; diagnostic imaging ; Humans ; Male ; Myocardial Infarction ; complications

OBJECTIVEThe exact mechanisms of defect closure in patients with perimembranous ventricular septal defect (PMVSD) remain unknown. We hypothesized that the expression of urokinase type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) may mediate extracellular matrix (ECM) remodeling in aneurysms.

METHODSeven normal heart tricuspid septal leaflet and 33 aneurysms were collected in Shanghai Renji Hospital and Shanghai Children's Medical Center from January 2008 to June 2010. Immunohistochemical expression of uPA and PAI-1 in 4 normal heart valvular tissues and 15 aneurysms was detected with immunohistochemical methods. The expression of uPA and PAI-1 mRNA in 3 normal heart valvular tissues and 7 aneurysms was studied by real time fluorescent PCR; the protein expression of uPA and PAI-1 in 4 normal heart valvular tissues and 11 aneurysms was tested with Western blotting.

RESULTThe surface of the aneurysms were completely covered by endothelial cells. Two types of granulation tissue, myxoid and fibrous, were associated with the aneurismal formation. uPA were recognized predominantly in valvar interstitial cells (VICs) which located mainly in regions adjacent to the endothelium and smooth muscle cells of blood vessels. PAI-1 was found in both VICs which located mainly in granulation tissue and endothelial cells. Nine aneurysms expressed a higher uPA activity than 4 normal valvular tissues ((74.6±11.8)% vs. (49.5±7.4)%; t = 3.87, P = 0.003) and six aneurysms expressed a low uPA activity ((10.3±3.1)% vs. (49.5±7.4)%; t=11.78, P=0.000) and a high PAI-1 activity ((55.2±1.7)% vs. (50.8±3.8)%; t=2.55, P=0.034) using immunohistochemical methods. uPA / PAI-1 ratio of protein expression tested by Western blot was 0.88±0.22 in four normal heart vavular tissues; five aneurysms expressed high uPA activity and low PAI-1 activity and uPA/PAI-1 ratio was 4.26±2.04; while the other 6 cases expressed low uPA activity and high PAI-1 activity and uPA/PAI-1 ratio was 0.30±0.07; the difference among the three groups was statistically significant (P<0.05). The rate of uPA/PAI-1 in relative copy of mRNA expression among normal heart valvular tissue, high uPA expressed aneurysms and low uPA expressed aneurysms are also significantly different (2.14±0.17 vs. 0.45±0.04; 2.14±0.17 vs. 4.38±1.41, P<0.05) respectively.

CONCLUSIONThe expression of uPA and PAI-1 in VICs suggests that interactions among these molecules contribute to the aneurysm formation and development. This provides a potential mechanism for defect closure in patients with PMVSD.

Aneurysm ; pathology ; Blotting, Western ; China ; Endothelial Cells ; cytology ; Extracellular Matrix ; metabolism ; Granulation Tissue ; pathology ; Heart Septal Defects, Ventricular ; pathology ; Humans ; Immunohistochemistry ; Plasminogen Activator Inhibitor 1 ; metabolism ; RNA, Messenger ; Urokinase-Type Plasminogen Activator ; metabolism

The clinic symptoms of cardiac occupying lesions are complex and difficult to diagnose currently. In this study, three cases of atrial angiosarcoma, left ventricular aneurysm and left ventricular diverticulum were selected, respectively. The clinical characteristics, imaging features (echocardiogram, cardiac CT and MRI) and the postoperative and pathological results for patients were studied. We compared the differences in clinical symptoms, morphology, histology and haemodynamics among the three patients. The diagnosis were confirmed by intraoperative and postoperative pathological examination. We conclude that proper imaging approaches would be beneficial to diagnose the cardiac occupying lesions. Accurate preoperative diagnosis is beneficial to preoperative preparation as well as the decrease in operative risks.
Diverticulum ; diagnosis ; Echocardiography ; Heart Aneurysm ; diagnosis ; Heart Ventricles ; pathology ; Hemangiosarcoma ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

Adult ; Calcinosis ; Heart Aneurysm ; pathology ; Heart Ventricles ; Humans ; Male ; Thrombosis ; pathology

Adolescent ; Aneurysm ; complications ; pathology ; Heart Neoplasms ; complications ; Heart Ventricles ; Hemangioma, Capillary ; complications ; Humans ; Male ; Pulmonary Artery ; Thrombosis ; complications ; pathology

OBJECTIVE: To determine the use of septal plication with Dor or Cooley procedure for post infarction anterior and anterior-septal aneurysm of the left ventricle. METHODS: A total of 23 patients with post infarction anterior and anterior-septal aneurysm of the left ventricle underwent septal plication and Dor or Cooley procedure along with coronary artery bypass grafting concomitantly. Data of NYHA grading, left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) were recorded before the surgery, before discharge and 3 months after the surgery. RESULTS: Compared with the preoperative data, the NYHA grading before the discharge and 3 months after the surgery improved from 3.21 ± 0.62 to 1.72 ± 0.31 and 1.57 ± 0.23(P<0.05); LVEDVI decreased from (102.31 ± 18.71) mL/m² to (62.11 ± 6.21) mL/m² and (54.63 ± 4.54) mL/m² (P<0.05); LVESVI decreased from (69.32 ± 17.48) mL/m² to (30.23 ± 3.25)mL/m² and (28.34 ± 3.12) mL/m²; while LVEF increased from (32.92 ± 8.12)% to (48.78 ± 4.51)% and (50.52 ± 4.68)% (P<0.05), respectively. CONCLUSION Ventricular septal plication combined with Dor or Cooley procedure can remarkably improve the left heart function in patients with post infarction ventricular aneurysm.
Aged ; Coronary Artery Bypass ; methods ; Female ; Heart Aneurysm ; etiology ; surgery ; Heart Ventricles ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; Ventricular Function, Left ; physiology ; Ventricular Septum ; surgery