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.
Comment:
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.