Table of Contents
Cardiovascular Pathology: A Subspecialty of Surgical Pathology Gayle L. Winters ix
Native Cardiac Valve Pathology John P. Veinot 327
Anatomy of the native cardiac valves, reasons for surgical excision and examination, and a summary of the gross examination and documentation are presented. Aortic stenosis, aortic valve regurgitation, tricuspid and pulmonary valve pathology, mitral stenosis, and mitral insufficiency are each presented with an overview, focused anatomy, and discussion of pathologic diagnosis by gross examination and histology.
Practical Approach to the Evaluation of Prosthetic Mechanical and Tissue Replacement Heart Valves Paul A. VanderLaan Robert F. Padera Fredrick J. Schoen 353
Mechanical and bioprosthetic substitute heart valves have dramatically improved life expectancy and quality of life in patients with valvular heart disease. Complications of substitute heart valves are a relatively infrequent occurrence, often due to thrombosis, infection, or structural/mechanical failure. It is important to accurately identify and systematically evaluate prosthetic heart valves when encountered as surgical pathology specimens or in the autopsy setting.
Cardiac Transplant Biopsies Gayle L. Winters 371
The endomyocardial biopsy remains the gold standard for assessing the status of the transplanted heart. It is the most consistently reliable method for the diagnosis and grading of acute cellular and antibody-mediated rejection. Recognition of specimen artifacts and other biopsy findings such as ischemic injury, Quilty effect, infection, and post-transplant lymphoproliferative disorder is important for accurate biopsy interpretation and differentiation from rejection. The endomyocardial biopsy provides important diagnostic information essential for optimal management of cardiac transplant recipients.
Diagnostic Biopsies of the Native Heart James R. Stone 401
Endomyocardial biopsy in the nontransplant setting can be diagnostic for particular diseases. Such disorders include amyloidosis, myocarditis, sarcoidosis, iron overload, glycogen storage disorders, and lysosomal storage disorders. The diagnostic features of these disorders on endomyocardial biopsy will be discussed along with the impact of endomyocardial biopsy-based diagnoses on patient management and prognosis.
Pathology of the Aorta Marc Halushka 417
The aorta is a distinctive surgical pathology specimen removed most frequently for aneurysm or dissection. Genetic syndromes, inflammatory processes and acquired diseases of aging result in aortic pathology; these are presented in terms of pathology, differential diagnosis and classification schemes. The pathologic context of a variety of commonly encountered histopathologies is described.
Surgical Pathology of Small-and Medium-Sized Vessels Michael A. Seidman Richard N. Mitchell 435
Surgical pathologists encounter blood vessels in virtually every specimen they receive, but pathologies intrinsic to the vessels themselves are distinctly less common. Nevertheless, there are a variety of specific diagnoses and procedures involving vascular specimens that merit the attention of the anatomic pathologist. Etiologically, such pathologies can be broadly grouped into traumatic, degenerative, congenital, inflammatory, infectious, and neoplastic lesions. Major examples of most of these are discussed, including anuerysms, vasculitis, thrombosis/embolism, and atherosclerosis.
Cardiac Tumors Dylan V. Miller 453
Cardiac neoplasms and other mass-forming lesions are not commonly encountered in surgical pathology practice. Fortunately, for the most part, these fall into a small group of well characterized and readily-recognized entities, although they are not without diagnostic dilemmas. A brief and practical synopsis of cardiac tumors is presented in this section with attention to more frequently encountered and clinically significant diagnostic challenges as well as pertinent clinical associations and prognostic information.
Examination of the Cardiac Explant Barbara A. Sampson 485
Examination of cardiac explants is a challenge to the surgical pathologist. This is due to the complex anatomy of the heart, the numerous pathologies unique to the heart, and the complexities of cardiovascular interventions including the transplant procedure itself. The dissection technique described permits complete evaluation of the heart with good photographic and histologic documentation while maintaining the integrity of the specimen.
Pathologic Evaluation of Cardiovascular Medical Devices Robert F. Padera 497
Cardiovascular devices such as coronary artery stents, ventricular assist devices, pacemakers, automated implantable cardioverter-defibrillators and septal closure devices are life saving and improve quality of life for millions of patients each year. Complications of these devices include thrombosis/thromboembolism, infection, structural failure and adverse material-tissue interactions. These findings should be sought when these devices are encountered on the surgical pathology bench or at autopsy.