Gross Description -- Repeat Heart Transplantation


The specimen is received unfixed labeled "heart". It consists of a 470 gram allograft heart, 14.0 x 14.0 x 5.0 cm. The epicardial surface is irregular, tan-yellow and hemorrhagic with minimal adhesions on the sternocostal surface. Received along with the main specimen are portions of right and left atria with attached blue polypropylene monofilament. A 9.0 x 4.0 x 1.0 cm. of left ventricle from the postero-lateral aspect has been previously resected for research purposes. On serial sectioning of the coronary arteries, the left main coronary artery is approximately 50% occluded by calcified and atheromatous plaque. The left anterior descending coronary artery is approximately 70% occluded by similar plaquing. The left circumflex is approximately 60% occluded by a similar atheromatous plaque. The right coronary artery is deeply hemorrhagic with occlusion, ranging from 80-85% by atheromatous plaquing. The distal two thirds of the heart is serially sectioned. The endocardium is tan and smooth. A 1.0 x 0.7 x 0.7 cm. gray and hemorrhagic thrombus is situated at the apex of the left ventricle. The myocardium is tan with areas of fibrosis noted in the left anterior wall and left intraventricular septum. The left free wall ranges from 1.2 to 1.3 cm. in thickness. The right ventricular free wall is approximately 0.4 cm. in thickness, tan, soft and free of infarcts. On further dissection of the left ventricle, the left anterior papillary muscle is severely fibrotic. The superior third of the heart is open according to blood flow. The tricuspid valve is pink, thin and delicate, 11.0 cm. in circumference. The pulmonic valve is pink-yellow, 9.0 cm. in open circumference with pliable valve cusps free of vegetation. The mitral valve is 11.0 cm. in circumference with pink, thin delicate leaflets. The chordae are thin and unfused. The aortic valve is 8.3 cm. in circumference with pink-yellow atheromatous plaquing. However, the valve cusps are pliable and free of vegetation. Representative tissue is frozen in bulk. Tissue was previously submitted for research. Gross photos are taken and sections are submitted.

Microscopic Description


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