PMC3554427_01
Left ventricular apical core specimen. Interstitial inflammatory infiltrate rich in lymphocytes (arrows) in an area of myocyte loss associated with peripheral myocyte injury (HPS, 20X).
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F1
Heartmate-II five days later. Histology of the LV-apical core section showed multifocal interstitial inflammatory infiltrates, predominantly lymphocytic, with edema and extensive mycocytes destruction, without giant cell or extensive necrosis (Figure 1).
Right ventriclular endomyocardial biopsy. Mixed inflammatory infiltrate with giant cells (arrows) in a background of severe myocytes dropout and features of granulation tissue (HPS, 20X).
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F2
An endomyocardial biopsy (EBM) revealed severe mycocytes' dropout, associated primarily with granulation tissue, a mixed inflammatory infiltrate and the presence of multinucleated giant cell with a non-myogenic appearance (Figure 2), all suggestive of GCM.
Native heart explants: Left ventricular section. Extensive interstitial fibrosis with residual areas of granulation tissue and mild lymphocytic infiltrates (HPS, 10X).
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F3
Histopathology of the explanted heart showed diffuse and irregular interstitial fibrosis, without extensive necrosis, associated with residual areas of granulation tissue, mild to moderate lymphocytic infiltrates and mild foci of myocytes damage (Figure 3).
Autopsy explants of the donor heart, section of the mid left anterior descending coronary artery. Severe concentric intimal atherosclerotic plaque with significant luminal stenosis (Movat, 20X).
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F4
At autopsy, no signs of giant cell or hyperacute rejection could be found; however, there was evidence of sub-acute myocardial ischemia and severe three-vessel disease (Figure 4), in spite of a reported 'normal' coronary angiogram at the donor site.