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Granulomatous myocarditis secondary to cornstarch
Insights
Surgical glove powder caused fatal cardiac inflammation and thrombus formation in a patient with rheumatic heart disease. This rare complication highlights the potential risks of foreign material in cardiac surgery.
Area of Science:
- Cardiovascular Pathology
- Surgical Complications
- Histopathology
Background:
- A patient with chronic rheumatic heart disease and mitral insufficiency underwent mitral valve replacement.
- Postoperatively, the patient developed sudden chest pain and hypotension, leading to death.
Observation:
- Autopsy revealed left atrial mural thrombi, with one obstructing the mitral orifice.
- Histology showed granulomatous and interstitial myocarditis affecting all heart chambers.
- Foreign bodies, identified as starch granules from surgical glove powder, were present within granulomas.
Findings:
- The foreign bodies stained with H&E, PAS, and Gram's iodine, and exhibited Maltese cross birefringence.
- These starch granules were morphologically identical to surgical glove powder.
- The cause of death was acute mitral occlusion due to a flapping mural thrombus.
Implications:
- This case illustrates a rare but potentially fatal complication of starch-based surgical glove powder.
- Highlights the importance of meticulous surgical technique and awareness of foreign body reactions in cardiac surgery.
- Underscores the need for alternative, non-particulate glove powders in cardiovascular procedures.
Abstract:
A 44-year-old white female with chronic rheumatic heart disease and mitral insufficiency was admitted to the hospital for cardiac catheterization and mitral valve replacement. On the ninth postoperative day the patient experienced a sudden onset of chest pain, hypotension, and died shortly therafter. Autopsy revealed multiple mural thrombi of the left atrium, one of which occluded the mitral orifice. Histologic examination showed a granulomatous and non-specific interstitial myocarditis involving all chambers of the heart. In the granulomas, both inside and outside giant cells, rounded foreign bodies were noted which stained light blue with hematoxylin and eosin, red with the periodic acid Schiff reagent, dark bluish-black with Gram's iodine, and showed Maltese cross birefringence under polarized light. These particles were identical with starch granules from surgical glove powder. The cause of death was acute mitral occlusion form a flapping mural thrombus.