PMC9613377_01
Diagram of the heart showing aneurysmal dilation of the coronary arteries highlighted in yellow and severe coronary artery atherosclerosis highlighted in red. Modified with permission from Creative Commons via Wikimedia Commons.
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Coronary evaluation demonstrated multiple aneurysms admixed with varying degrees of atherosclerotic stenosis (detailed summary in Figure 1 and Table 1).
A - Fresh magnified gross view of the serial sections of the left anterior descending coronary artery (base of the heart and mid proximal left anterior descending coronary artery in the left side of the photo and apex and mid distal left anterior descending coronary artery in the right side of the photo) with variable degrees of coronary artery aneurysms up to 1.8 cm in diameter (scale bar= 1cm); B - 1 x view of microscopic slides showing dilation of the circumference of the left anterior descending coronary artery (scale bar= 1cm); C and D - 10 x and 40 x view of Verhoeff-van Gieson (VVG) stain of the left anterior coronary artery showing destruction of the tunica media with loss of smooth muscle, disarray "pale" degenerated areas, and elastic media fragmentation.
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The Figure 2 shows the gross images of the left circulation with marked aneurysmal dilation and severe coronary artery atherosclerosis.
A - Fresh gross view of right coronary artery with aneurysmal dilation, partial luminal occlusion and recanalization (scale bar= 1 cm); B - 10 x view of VVG special stain of segment of the right coronary artery showing numerous small lumens lined by new endothelium, consistent with areas of old thrombosis and recanalization; C - Fixed gross view with complete occlusion of the left circumflex coronary artery by atherosclerotic plaque (scale bar= 1 cm); D - 10 x view of hematoxylin and Eosin (H&E) stained section showing left circumflex coronary artery with complete occlusion by calcified atherosclerotic plaque.
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The Figure 3 shows the gross images of the right circulation with histologic changes consistent with old thrombosis and recanalization.
A - Fresh gross view of the transverse section of myocardium showing large transmural ventricular scars in the lateral/posterior left ventricle and focally in the subendocardial region of the anterior ventricle (scale bar= 3 cm); B - 20 x Gomori trichrome stain of myocardium (lateral/posterior aspect of the left ventricle) show extensive fibrosis consistent with remote myocardial infarcts.
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The Figure 4 shows gross images of extensive remote myocardial infarcts and histology from the lateral/posterior left ventricular wall with replacement of muscle fibers by dense collagen.