Congestive cardiomyopathy and spasm of coronary microvascularisation in man. Electron microscopic evidence

This paper reports our observations of right ventricular biopsies taken from a 23 year old patient with a congestive cardiomyopathy. The ultrastructural examination of these samples revealed coronary capillary and arteriolar spasms, as well as an ischemic aspect of the myocytes. The responsibility of the coronary microcirculation in the genesis of dilated cardiomyopathies has been suspected for a long time. It has recently been demonstrated in the Syrian hamster, but it has never been clearly evidenced in man. The case that we present seems to confirm this hypothesis. The fact that the spasm is a transitory phenomenon and that it most probably does not involve all areas of the myocardium simultaneously could explain the difficulty encountered in observing this phenomenon in endomyocardial biopsies.