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Ventricular aberrant bands and hypertrophic trabeculations. A clinical pathological correlation
A Keren1, M E Billingham, R L Popp
1Department of Medicine, Stanford University School of Medicine, California.
Insights
Dilated cardiomyopathy patients show higher prevalence of left ventricular aberrant bands and hypertrophic trabeculations compared to ischemic heart disease. These findings aid in pathological definition and understanding of cardiac abnormalities.
Area of Science:
- Cardiovascular Pathology
- Cardiac Surgery
Background:
- Aberrant bands and hypertrophic trabeculations are observed in cardiac pathology.
- Their precise definition and prevalence in different heart conditions require further elucidation.
Purpose of the Study:
- To pathologically define left ventricular (LV) and right ventricular (RV) aberrant bands and hypertrophic trabeculations.
- To compare their prevalence and characteristics in dilated congestive cardiomyopathy versus ischemic heart disease.
Main Methods:
- Review of clinical, hemodynamic, and pathology data from 22 dilated congestive cardiomyopathy and 13 ischemic heart disease patients undergoing heart transplantation.
- Morphological and histological analysis of aberrant bands and trabeculations.
Main Results:
- Prevalence of LV aberrant bands was 37% and RV was 28%.
- Prevalence of LV hypertrophic trabeculations was 43% and RV was 28%.
- Dilated cardiomyopathy patients had higher prevalence of LV aberrant bands and hypertrophic trabeculations compared to ischemic heart disease patients.
- Aberrant bands associated with dilated cavities; hypertrophic trabeculations with ventricular hypertrophy and smaller LV size.
- Proposed classification of aberrant bands into genuine (congenital) and secondary (pathology-induced) types.
Conclusions:
- Aberrant bands and hypertrophic trabeculations exhibit distinct morphological features and associations with cardiac conditions.
- Distinguishing between genuine and secondary bands is crucial for understanding their origin and implications.
- These findings contribute to the pathological definition of ventricular anomalies.
Abstract:
We reviewed the clinical, hemodynamic, and pathology data of 22 patients with dilated congestive cardiomyopathy and 13 patients with ischemic heart disease who underwent heart transplantation, primarily to improve the pathological definition of left ventricular (LV) and right ventricular (RV) aberrant bands and hypertrophic trabeculations. Overall prevalence of aberrant bands was 37% in th LV and 28% in the RV. Similar values for hypertrophic trabeculations were 43% and 28%, respectively. Compared with ischemic heart disease, our patients with dilated congestive cardiomyopathy had similar ventricular size and wall thickness, but had a higher prevalence of LV aberrant bands (p = .005) and LV hypertrophic trabeculations (p = .01). Aberrant bands were associated, both in the LV and RV, with dilated cavities (p less than .05), whereas hypertrophic trabeculations were associated with more ventricular hypertrophy and smaller LV size. Following morphological and histological analysis of the aberrant bands, we propose their division into two categories: genuine or primary bands (probably congenital in origin) and secondary bands, which most probably represent trabecular structures that develop a free cavitary course following pathological changes in the ventricular wall structure and cavitary geometry. Compared with the muscular RV bands situated mostly in the distal portion of the ventricle, LV bands were usually fibrotic and had at least one point of insertion in the inflow or outflow tract. The pattern of trabecular hypertrophy was also different in the two ventricles. Ventricular arrhythmias and thrombi occurred equally in patients with and without bands or trabeculations.