PMC5803986_01
(a) Heart, anterior surface - cardiomegaly, aneurysmal dilatation A distal to the left subclavian artery, anomalous collaterals (arrow) distal to aneurysm; (b) heart, posterior surface -constriction beyond aneurysm A. Descending thoracic aorta DTA is supplied by bunch of anomalous collateral arteries (arrows). The ductus is closed. AA: Ascending aorta, LCCA: Left common carotid artery, LA: Left atrium, LPA: Left pulmonary artery, LV: Left ventricle, PT: Pulmonary trunk, RAA: Right atrial appendage, RBCA: Right brachiocephalic artery, RPA: Right pulmonary artery, RV: Right ventricle
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F1
Just distal to the origin of the left subclavian artery [LSA, Figure 1], however, there was fusiform aneurysmal dilation of the proximal 4 cm of the descending thoracic aorta, which had a diameter of 3.5 cm.
Serial longitudinal sections for the site of constriction show in (a and b) luminal discontinuity between the proximal and distal segments, (c) confirmed on histopathology (scanned slide); (d) (H and E, x250) and (e) (H and E, x400) shows complicated atherosclerosis in the aneurysmal wall proximal to the interruption with luminal thrombus T; (f) (H and E, x250) and (g) (H and E, x400) shows near normal wall distal to the interruption
APC-11-92-g002.jpg
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F2
A distinct constriction was found just beyond the aneurysm, with serial longitudinal sections at this site showing lack of communication with the descending thoracic aorta, a finding confirmed by subsequent microscopy [Figure 2].
(a) LV outflow tract showing bicuspid AV and a niche (arrow) in the interventricular septum. The LCA is critically stenosed (LV: Left ventricular, AV: Aortic valve LCA: Left circumflex artery, AA: Ascending arota, LAA: Left atrial appendage, MV: Mitral valve); (b) Fibrous tract (arrow) at the niche produced by the closed muscular ventricular septal defect (LVC: Left ventricular cavities, RVC: Right ventricular cavities); left anterior descending artery, (c and d) (scanned slide) critical stenosis by atheroma; (e) At shoulder S, there is fibrous cap FC erosion (arrows) with fresh thrombus. The core C is lipid rich (H and E, x250)
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F3
Further examination of the heart revealed bicuspid aortic valve (anterior to posterior type) [Figure 3a], moderate concentric left ventricular hypertrophy, and evidence of spontaneous closure of a preexisting trabecular muscular ventricular septal defect [Figure 3b]. All the coronary arteries were diffusely atherosclerotic, with multifocal critical stenosis [Figure 3c and d]. The left anterior descending artery, 3 cm from its origin, showed luminal occlusion for a length of 0.8 cm produced by a fresh organizing thrombus which had developed over an eroded atherosclerotic plaque [Figure 3e].