Final Diagnosis -- Coronary Graft Vascular Disease (Repeat Heart Transplantation)

FINAL DIAGNOSIS:

ALLOGRAFT HEART (470 GRAMS), ORTHOTOPIC HEART TRANSPLANTATION -

A. SEVERE CORONARY ATHEROSCLEROSIS WITH SUBSTANTIAL OCCLUSION OF THE LEFT ANTERIOR DESCENDING AND RIGHT CORONARY ARTERIES.

1. FIBRO-OBLITERATIVE CHANGES OF THE SMALLER ARTERIAL BRANCHES.

2. MODERATE LYMPHOCYTIC INFILTRATION OF THE CORONARY ARTERIAL WALL.

B. MODERATE INTERSTITIAL FIBROSIS AND SCARRING WITH MYOCYTE HYPERTROPHY AND DISARRAY.

C. NO EVIDENCE OF ACUTE CELLULAR REJECTION.

D. RECENT MURAL THROMBUS OF THE LEFT VENTRICLE.

E. ENDOCARDIAL QUILTY LESION.

Overall, the changes are consistent with an ischemic process resulting from coronary atherosclerosis. Both progressive donor disease and chronic vascular rejection could be responsible for the arterial alterations.