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Ultrastructural and histological study of left ventricular myocardium in mitral stenosis. Correlations with angiocardiographic indices of left ventricular function (in 11 observations)

Ultrastrukturelle und histologische Untersuchungen des linksventrikulären Myokards bei Mitralstenose. Korrelationen mit angiokardiographischen Indizes der Funktion des linken Ventrikels

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Summary

Left ventricular myocardial biopsies were performed during surgery in 11 patients with pure and isolated mitral stenosis. Patients had undergone a preoperative angiocardiographic study of left ventricular function. Biopsy specimens were examined with the light and electron microscope.

Myocyte cell diameter was normal (20±1.6 μ). Lesions existed which were probably degenerative, including anarchy and irregularities of sarcomeres, Nemaline Myopathy-type Z line changes and alterations of intercalated discs. A moderate fibrosis was found in the interstitial spaces with very few histiocytes. The coincidence planimetry study of the interstitial spaces showed a 37±5.5% increase compared to a control group with no fibrosis (23±1.5%, p<0.01).

The angiocardiographic indices of left ventricular function were all decreased. Only four subjects had normal left ventricular function (EF≥55%).

Nevertheless, it was not possible to establish a significant correlation between the extent of fibrosis and the decrease of left ventricular function. Although left ventricular fibrosis could be one of the factors responsible for decreased myocardial function, it is not sufficient to explain the changes of left ventricular function which are rather frequently observed in mitral stenosis.

Zusammenfassung

Bei 11 Patienten mit reiner Mitralstenose wurden während der Herzoperation Myokardbiopsien vom linken Ventrikel entnommen. Vor der Operation wurde eine angiographische Studie der Funktion des linken Ventrikels durchgeführt. Das Biopsiematerial wurde lichtmikroskopisch und elektronenmikroskopisch untersucht.

Der Zelldurchmesser der Myozyten war normal (20±1,6 μ). Es fanden sichwahrscheinlich degenerativ bedingte—Läsionen mit irregulärer Anordnung der Sarkomeren, Z-Linien-Änderungen wie bei Nemaline-Myopathie und Änderungen der Disci intercalares. Außerdem fand sich eine mäßige Fibrose im Interstitium mit sehr wenigen Histiozyten. Die Planimetrie der Interstitialräume ergab einen Zuwachs um 37±5,5%, verglichen mit einer fibrosefreien Kontrollgruppe (23±1,5%, p<0,01).

Alle angiokardiographischen Indizes für die Funktion des linken Ventrikels waren herabgesetzt. Nur 4 Patienten hatten eine normale Ventrikelfunktion (Austreibungsfraktion ≥55%).

Trotzdem war es nicht möglich, eine signifikante Korrelation zwischen dem Ausmaß der Fibrose und der Beeinträchtigung der linksventrikulären Funktion nachzuweisen. Obwohl die Fibrose des linken Ventrikels einer der Faktoren für eine Beeinträchtigung der myokardialen Funktion sein könnte, reicht sie nicht aus, um die Funktionsänderungen des linken Ventrikels zu erklären, die bei Mitralstenose häufig beobachtet werden.

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Abbreviations

MS:

Mitral Stenosis

S:

Sinusal rhythm

AF:

Atrial Fibrillation

FC:

Functional Class

CTR:

Cardiothoracic Ratio

MA:

Mitral Area

RR′:

period

CI:

Cardiac Index

SPA:

Systolic Pulmonary Pressure

LVEDP:

Left Ventricular End-diastolic Pressure

EDV:

End Diastolic Volume

SV:

Stroke Volume

ΔD:

Extent of fiber shortening

EF:

Ejection Fraction

VCF:

Mean Velocity of Circumferential Fiber

CD:

Cellular Diameter

IS:

Interstitial Space

m:

mean value

s:

standard deviation

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Author notes

  1. F. Herreman

    Present address: Laboratoire d'Hémodynamique et d'Angiocardiographie, Service des Maladies Cardiovasculaires, Hôpital Cochin, 27 Rue du Faubourg St. Jacques, 75014, Paris, France

Authors and Affiliations

  1. Unité de Recherches de Pathologie Cardiovasculaire, I.N.S.E.R.M., Hôpital Léon Bernard, Limeil-Brevannes, France

    J. Perennec,  F. Herreman, A. Ameur, M. Degeorges & P. Y. Hatt

  2. Service des Maladies Cardiovasculaires du Professeur M. Degeorges, Hôpital Cochin, Paris, France

    J. Perennec,  F. Herreman, A. Ameur, M. Degeorges & P. Y. Hatt

  3. Service de Chirurgie Cardiovasculaire du Professeur C. Cabrol, Hôpital Pitié-Salpétrière, Paris, France

    J. Perennec,  F. Herreman, A. Ameur, M. Degeorges & P. Y. Hatt

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Additional information

With 6 figures and 1 table

D.G.R.S.T. Grant No. 77 7 1030.

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Perennec, J., Herreman, F., Ameur, A. et al. Ultrastructural and histological study of left ventricular myocardium in mitral stenosis. Correlations with angiocardiographic indices of left ventricular function (in 11 observations). Basic Res Cardiol 75, 353–364 (1980). https://doi.org/10.1007/BF01907583

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