Granulomatous myocarditis secondary to cornstarch

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.