SPECIFIC FEATURES OF PRE-TRANSPLANTATION MYOCARDIAL PATHOLOGY IN PATIENTS UNDERGONE HEART TRANSPLANTATIONS
Objective. To improve the pre-transplantation myocardial pathology diagnosis by determining its structure and identifying the recipient’s explanted heart clinical and morphological features after the heart transplantation (HT) and comparing the findings.
Materials and methods. 150 hearts explanted in HT and 50 donor hearts with brain death not used for HT were studied in macro- and micro-investigations.
Results. A discrepancy in the clinical pre-transplantation diagnosis and the pathomorphologic one was found in 25.3% (38 of 150). It was most difficult to diagnose clinically postmyocardic cardiosclerosis (PMCS) which was regarded as dilated cardiomyopathy (DCMP) in 20 (21.7%) cases, as ischaemic cardiomyopathy (ICMP) in 4 (8.7%) cases and was diagnosed correctly in 1 (4%) case. Differential diagnosis of the diseases represented by chronic rheumatic heart disease (CRHD) and myocarditis terminal stages was also difficult: 10 (6.7%) cases had not been recognized. The following macroscopic features were identified in PMCS: thickened interventricular septums and increased tricuspid valve perimeters. The diagnoses were inconsistent in 22.6% of patients (12 of 53) who underwent surgeries at the preoperative stage the main unidentified diseases being PMCS (6 cases, or 50%) and giant cell myocarditis (2 cases, or 16.7%).
Conclusion. The pre-transplantation diagnosis of the terminal heart failure with cardiac dilation in some cases being significant (myocarditis and PMCS) for the subsequent management and the endomyocardial biopsy evaluation for making decision on whether there is a rejection or a disease recurrence is rather difficult.