Cardiac Path Online
Heart Transplants - Pathological Examination
Reporting of endomyocardial biopsy (Allograft
Heart specimen is usually submitted fresh.
Occasionally, the pathologist will also receive small portions of the donor heart. (Example: Auricular appendages).
Processing the specimen:
(1) In general, hearts are cut after fixation in a manner dictated by the pathology to be demonstrated.
Hearts with ischaemic heart disease are cut transversely at approximately 1 to 2 cm intervals beginning at the apex to the level of the mitral valve ("serially sectioned").
The base of the heart may be cut longitudinally or open according to the line of flow.
(2) Weight of the specimen. Normal weights for the entire heart are 270-360 g for males and 250-280 g for females.
(3) Describe epicardial surface including pericardial fat (abundant, scant), petechiae , adhesions.
(4) Describe each ventricle separately including hypertrophy or dilatation, fibrosis (endocardial, epicardial, transmural, location and degree), infarcts (old or recent, size, location, transmural or subendocardial ), trabeculations, papillary muscles (hypertrophied, thinned, scarred, infracted), presence of mural thrombus.
Measure the wall thickness or both ventricles. Normal thickness of the left ventricle is 0.9 to 1.5 cm and the right ventricle is 0.25 to 0.3 cm.
(5) Describe atria if there are any endocardial lesions.
(6) Describe any valve lesions as in section above (native or prosthetic).
(7) Atherosclerotic coronary arteries are dissected from the heart, fixed and decalcified and sectioned transversely at 3 to 5 mm intervals.
Soft unobstructed coronary arteries may be carefully cut in transverse sections on the fixed heart at 3 mm intervals.
Describe the coronary arteries , percent of luminal compromise, location, recent thrombi or plaque hemorrhage, and the locations of these lesions.
(8) Describe any bypass grafts including type (saphenous vein, left internal mammary), location of graft to native vessel patency.
(9) Describe amount and type of tissue taken for research, name of the principal investigator taking the tissue.
(10) Submit three sections of the left ventricular free wall (base, lateral and apex in one cassette), two sections from right ventricular free wall (base and apex in one cassette and two sections from the septum (base and apex in one cassette).
Additional cassettes are submitted to document native coronary arteries, coronary artery grafts and any other gross lesions.
Complications of Heart Transplantation:
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