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Histopathologic and ultrastructural observations of acute and convalescent myocarditis: A serial endomyocardial biopsy study

  • Viral And Other Myocarditis
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Summary

Serial endomyocardial biopsy findings were analyzed in ten cases with acute myocarditis of possible viral origin. The histopathologic findings were analyzed at the acute (0–10 days after the onset), subacute (11–21 days), and convalescent stages (22–167 days). The incidence and severity of various cardiac myocyte and interstitial changes were compared at each stage of the disease.

The time-course changes of the histopathologic findings in acute myocarditis were as follows. At the acute stage, we observed: (1) interstitial cell infiltration composed of fibroblasts, macrophages, and lymphocytes, (2) fragmentation of the muscle bundles, (3) myocytolytic changes, (4) swelling and scarcity of the cytoplasm and swelling of nuclei, (5) variation in size of the myocytes, (6) disarrangement of the muscle bundles, (7) interstitial edema, (8) increased glycogen deposition in the myocytes, (9) abnormal branching of the myocytes, and (10) interstitial fibrosis. At the convalescent stage, most of the above findings could still be seen except for myocytolytic changes, swelling of myocytes, and interstitial edema. At the subacute and convalescent stages, an increase in abnormal branching and in double nuclei in the myocytes and nuclear degeneration became observable. A further control study comparing the changes at the convalescent stage of myocarditis and the myocardial changes in cases with chronic right ventricular overload in 58 cases revealed that in the former fragmentation of the muscle bundles, abnormal branching, size variation, glycogen deposition, and large mononuclear cell infiltrations were significantly more frequent.

Ultrastructural observation of the myocytes revealed that they have a great potentiality for regeneration; myocytes showing severe myocytolytic changes may recover to regain an architecture of almost normal appearance.

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References

  1. Kawai C, Matsumori A, Kitaura Y, Takatsu T (1978) Virus and the heart: Viral myocarditis and cardiomyopathy. In: Yu PN, Goodwin JF (eds) Progress in Cardiology, Lea & Febiger, Philadelphia, pp 141–162

    Google Scholar 

  2. Woodruff JF (1980) Viral myocarditis. A review. Am J Pathol 101: 427–279

    Google Scholar 

  3. Sekiguchi M, Hiroe M, Take M, Hirosawa K (1980) Clinical and histopathological profile of sarcoidosis of the heart and acute myocarditis: II. Myocarditis. Jpn Circul J 44: 264–273

    Google Scholar 

  4. Take M, Sekiguchi M, Hiroe M, Hirosawa K (1981) Early clinical profiles of histopathologically proven cases with acute idiopathic myocarditis and a proposal for diagnostic criteria. Jpn Circul J 45: 1415–1420

    Google Scholar 

  5. Take M, Sekiguchi M, Hiroe M, Hirosawa K (1982) Long-term follow-up of electocardiographic findings in patients with acute myocarditis proven by endomyocardial biopsy. Jpn Circul J 46: 1227–1234

    Google Scholar 

  6. Yu Z-X, Sekiguchi M, Hiroe M, Take M, Hirosawa K (1984) Histopathological findings of acute and convalescent myocarditis obtained by serial endomyocardial biopsy. Jpn Circul J 48: 1368–1374

    Google Scholar 

  7. Sekiguchi M, Hiroe M, Take M (1979) On the potentiality of myocardial cell regeneration. Ultrastructural observation employing serial endomyocardial biopsy in 9 cases of acute myocarditis. J Moll Cell Cardiol, Suppl 3: 21 (abstract)

    Google Scholar 

  8. Yu Z-X, Sekiguchi M, Hiroe M, Take M, Hirosawa K (1985). A comparative ultrastructural study on the nature of interstitial cell constituents in idiopathic myocarditis and myocardial infarction. In: Sekiguchi M, olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 154–158

    Google Scholar 

  9. Yu Z-X, Sekiguchi M, Hiroe M, Hasumi M, Morimoto S, Hirosawa K (1985) On the interstitial fibrotic changes in acute and convalescent myocarditis obtained by serial endomyocardial biopsy. Jpn Circul J (submitted)

  10. Ogasawara S, Hiroe M, Matsuda M, Obunai Y, Sekiguchi M (1985) A case of acute idiopathic myocarditis with four serial endomyocardial biopsies during 67 days. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 309 (abstract)

    Google Scholar 

  11. Hiroe M, Sekiguchi M, Morimoto S, Take M, Hirosawa K (1985) Relation of hemodynamics in acute myocarditis to a quantitative histopathologic analysis employing endomyocardial biopsy. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 310 (abstract)

    Google Scholar 

  12. Hiroe M, Sekiguchi M, Take M, Matsuda M, Hirosawa K (1985) Hemodynamic studies and response to a combined therapy of nitroglycerin ointment and dopamine in patients with acute myocarditis. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 180–186

    Google Scholar 

  13. Sekiguchi M, Hiroe M, Take M, Akamatsu T, Takahashi S (1980) Vasodilator therapy in congestive cardiomyopathy and myocaritis. In: Sekiguchi M, Olsen EGJ (eds) Cardiomyopathy. Clinical, pathological and theroretical aspects, University of Tokyo Press, Tokyo and University Park Press, Baltimore. PP: 257–275

    Google Scholar 

  14. Hasumi M, Sekiguchi M, Morimoto S, Take M, Hirosawa K (1983) Ventriculographic findings at the convalescent stage in eleven cases with acute myocarditis. Jpn Circul J 47: 1310–1316

    Google Scholar 

  15. Hiroe M, Sekiguchi M, Take M, Kusakabe K, Shigeta A, Hirosawa K (1985) Long follow-up study in patients prior myocarditis by radionuclide methods. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 199–203

    Google Scholar 

  16. Kawana R (1985) Cardiovascular diseases due to viruses. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocaritis and related disorders. Heart and Vessels (Suppl 1): 91–96

    Google Scholar 

  17. Fiedler A. (1899) Über akute intestitielle Myokarditis Vortrage Gesellschaft Natur und Heilkunde Dresden 9.10.1897; ausführliche Festschrift zur Feier des fünfzigsten Bestehens des Stadtkrankenhauses zu Dresden-Friedrichstadt. W. Baensch, Dresden, pp 3–24

    Google Scholar 

  18. Jarco S (1973) Fiedler on acute interstitial myocarditis (1899) -II. Am J Cardiol 32: 716–718

    Google Scholar 

  19. Jarco S (1973) Fieder on acute interstitial myocarditis (1899) -I. Am J Cardiol 32: 221–223

    Google Scholar 

  20. Mason JW, Billingham ME, Ricci DR (1980) Treatment of acute inflammatory myocarditis assisted by endomyocardial biopsy. Am J Cardiol 45: 1037–1044

    Google Scholar 

  21. Fenoglio JJ, Ursell PC, Kelogg CF, Pil M, Drusin RE, Weiss MB (1983) Diagnosis and classification of myocarditis by endomyocardial biopsy. N Engl J Med 308: 12–18

    Google Scholar 

  22. Sekiguchi M, Tosaka M, Hiroe M, Abe K, Hirosawa K (1979) Ultrastructure of the myocarditium in surgically excised post-myocardial infarction ventricular wall. J Electron Microsc 12: 638–639

    Google Scholar 

  23. Van Vilet PD, Burchell HB, Titus TL (1966) Myocarditis associated with pheochromocytoma N Engl J Med 274: 1102

    Google Scholar 

  24. Sekiguchi M, Hiroe M, Kasanuki H, Ohnishi S, Hirosawa K (1984) Experience of 100 atrial endomyocarial biopsy and concept of atrial cardiomyopathy. Circulation 70: 118 (abstract)

    Google Scholar 

  25. Sekiguchi M, Hiroe M, Ogasawara S, Nishikawa T (1981) Practical aspects of endomyocardial biopsy. Ann Acad Med Singapore 10, Suppl: 115–128

    Google Scholar 

  26. Sekiguchi M, Takao A, Endo M, Asai T, Kawasaki T (1985) On the mucocutaneous lymph node syndrome or Kawasaki disease In: Yu PN and Goodwin JF (eds) Progress in cardiology No. 13, Lea & Febiger, Philadelphia (In print)

    Google Scholar 

  27. Yutani C, Odano K, Kaniya T (1980) Histopathological study on right endomyocardial biopsy of Kawasaki disease. Br Heart J 43: 589–592

    Google Scholar 

  28. Spry CJF, Take M, Tai PC (1985) Eosinophilic disorders affecting the myocardium and endocardium: A review. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 240–242

    Google Scholar 

  29. Take M, Sekiguchi M, Hiroe M, Suzuki S, Ogasawara S, Omori M, Hirosawa K, Shirai T, Ishide T, Okubo S (1985) Clinical spectrum and endomyocardial biopsy findings in eosinophilic heart disease. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 243–249

    Google Scholar 

  30. O'Connell JB, Robinson JA, Subramanlian R, Scanlon PJ (1984) Endomyocardial biopsy: Technique and applications in heart disease of unknown cause. Heart Transplantation 3: 132–143

    Google Scholar 

  31. Fowles RE, Mason JW (1984) Role of cardiac biopsy in the diagnosis and managemant of cardiac disease. Prog Cardiovasc Dis 27: 153–172

    Google Scholar 

  32. Take M, Sekiguchi M, Hiroe M, Hirosawa K (1985) A clinicopathologic study on a cuase of idiopathic cardiomyopathy and arrhythmia and conduction disturbance employing endomyocardial biopsy. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 159–164

    Google Scholar 

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This study was supported by a grant from the Japan Research Promotion Society for Cardiovascular Disease

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Sekiguchi, M., Yu, ZX., Hasumi, M. et al. Histopathologic and ultrastructural observations of acute and convalescent myocarditis: A serial endomyocardial biopsy study. Heart Vessels 1 (Suppl 1), 143–153 (1985). https://doi.org/10.1007/BF02072382

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