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Pathologic study of myocardial infarction of the right ventricle
Abstract:
To evaluate pathologic features of myocardial infarction of the right ventricle (MI-RV), we analyzed 106 autopsy cases with transmural myocardial infarction (MI) (fresh in 46 cases and healed in 60). Anterior MI was observed in 47, posterior MI in 54 and lateral in 5. There were 13 cases (12%) with MI-RV (anterior in 1 case and posterior in 12), which included 10 cases with fresh MI and 3 with healed MI. All cases with MI-RV had associated transmural interventricular septal infarction. Of the 13 cases with MI-RV, 9 (69%) had right ventricular dilatation (RVD) and 2 had right ventricular hypertrophy. Extensive MI-RV (more than 1/3 of the right ventricle) was observed in 8 (89%) of those with RVD. Of 93 cases of MI without MI-RV, 14 (16%) had RVD. The incidence of RVD was greater in cases with MI-RV than in those without (p less than 0.005). All 12 cases with posterior MI-RV had significant (greater than or equal to 75%) narrowing of the right coronary artery (RCA), and 19 cases (87%) of those with posterior MI without MI-RV, had similar lesions. In conclusion, the incidence of RVD and significant narrowing of RCA was greater in cases with posterior MI-RV than in those with posterior MI.
Insights
Myocardial infarction of the right ventricle (MI-RV) is often associated with interventricular septal infarction. Right ventricular dilatation (RVD) is more common in MI-RV cases, particularly with posterior MI-RV and significant right coronary artery narrowing.
Area of Science:
- Cardiovascular Pathology
- Cardiac Imaging and Diagnostics
Background:
- Myocardial infarction (MI) commonly affects the left ventricle, but right ventricle involvement (MI-RV) has distinct pathological features.
- Understanding the prevalence and characteristics of MI-RV is crucial for accurate diagnosis and prognosis.
Purpose of the Study:
- To investigate the pathological features of myocardial infarction of the right ventricle (MI-RV).
- To determine the association between MI-RV and right ventricular dilatation (RVD) or hypertrophy.
- To explore the relationship between MI-RV, particularly posterior MI-RV, and right coronary artery (RCA) stenosis.
Main Methods:
- Analysis of 106 autopsy cases with transmural myocardial infarction (MI), including fresh and healed stages.
- Classification of MI location (anterior, posterior, lateral) and assessment for MI-RV.
- Evaluation for associated findings such as interventricular septal infarction, right ventricular dilatation (RVD), and right ventricular hypertrophy.
- Correlation of MI-RV with the severity of right coronary artery (RCA) narrowing.
Main Results:
- 13% of MI cases exhibited MI-RV, predominantly posterior, and all had associated transmural interventricular septal infarction.
- Right ventricular dilatation (RVD) was significantly more frequent in cases with MI-RV (69%) compared to those without (16%).
- Posterior MI-RV cases showed a higher incidence of significant (≥75%) right coronary artery (RCA) narrowing compared to posterior MI without RV involvement.
Conclusions:
- MI-RV is frequently associated with interventricular septal infarction and a higher incidence of RVD.
- Posterior MI-RV is strongly linked to significant RCA stenosis, suggesting a key role for RCA pathology.
- Pathological evaluation of MI-RV provides insights into cardiac remodeling and coronary artery disease severity.