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Forms of cardiac rejection
Cardiac allograft dysfunction workup
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T2 cardiac MRI
Hyperenhancement on cardiac MRI
Doppler echocardiography
Doppler strain
Contributed by Carolyn Glass, M.D., Ph.D.
ISHLT 0R
ISHLT 1R
ISHLT 2R
ISHLT 3R
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Biopsy proved ATTR cardiac amyloidosis with positive uptake
Contributed by Jaishree Jagirdar, M.D.
Amyloid deposition in myocardium
Trichrome stain
Crystal violet stain
Congo red stain
Congo red stain
Contributed by Bradley Farris, M.D.
Amyloid deposition with beta pleated sheets
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Classification of coronary anomalies
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MRI during cardiac systole and end diastole
Coronary arteries with 3D reconstructions
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Chest radiograph
Ultrasound
Computed tomography
Angiography
50 mm round mass with calcification
Coronary angiogram
After CABG
Distal left main aneurysm
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Descending artery aneurysm
Contributed by Carla Dominguez Gonzalez, B.S.
Autopsy findings
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Right coronary artery
Contributed by Carla Dominguez Gonzalez, B.S.
Abdominal aortic aneurysm with rupture
Thoracic aortic aneurysm
Severe medial atrophy
Elastic lamellar disruption
Adventitia inflammation and lipid deposition
Alcian blue staining - MEMA
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Increase of transverse cardiac diameter
Enlargement of right ventricle and atrium
Cardiac echocardiogram
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Severe dilation of RV
RV dilatation
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Early fibrosis and adipocytes infiltration
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Coronary angiogram
Intravascular ultrasound
Multidetector computed tomography
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Coronary artery atherosclerosis
Aorta involved by
atherosclerosis
Contributed by Robert F. Corliss, M.D. and Jefree J. Schulte, M.D.
Coronary artery plaque
Coronary artery thrombus
Coronary artery recanalized thrombus
Coronary plaque with early thrombus
Lipid rich plaque
Foam cells
Cholesterol clefts
Contributed by Stephen P. Sanders, M.D.
MRI (cine SSFP)
MRI (LGE technique)
Contributed by Chrystalle Katte Carreon, M.D. and AFIP
Macroscopic features
Cut surface features
Large septal mass
Homogeneous mass
Large circumscribed mass
Contributed by Chrystalle Katte Carreon, M.D.
Abundant collagen
Immature appearance
Entrapped myocardium
Dystrophic calcifications
Lack of tumor capsule
Entrapped myocardium (desmin)
Abundant elastic fibers
AFIP images
Cellular lesion in infant
Collagen deposition
Central fibroma cells
Calcification
Infiltrative margin
Trichrome
Von Gieson elastin
Contributed by Giuseppe Vergaro, M.D., Ph.D. and Vladyslav Chubuchnyi, M.D.
2D echocardiography
Cardiac magnetic resonance
Contributed by Angela Pucci, M.D., Ph.D. and Giovanni Bartoloni, M.D.
Polypoid
Hemorrhage
Villous morphology
Soft and friable projections
Chalky aspect
Contributed by Angela Pucci, M.D., Ph.D. and @DrTravisBrown on Twitter
Left atrial myxoma
Myxoma cell nest
Myxoma cells in cord structure or isolated
Myxoma cells around blood vessel
Gandy-Gamna bodies
Gandy-Gamna bodies (Perls staining)
Inflammatory infiltrates
Hemorrhage
Glands in cardiac myxoma
Calretinin
CD31+ vessels
S100 immunoreactivity
αSMA+
CK+ gland in cardiac myxoma
Cardiac myxoma
Contributed by Angela Pucci, M.D., Ph.D. and Giovanni Bartoloni, M.D.
Myxoma cell
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Trisomy 13
ADS and VSD
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Arteriographic classification
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Coronary angiography
CT angiography
Intravascular ultrasound
Coronary angiography
Optical coherence tomography
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Coronary artery hyperplasia
Contributed by Carolyn Glass, M.D., Ph.D.
Explant, concentric intimal hyperplasia
Explant, diffuse intimal hyperplasia
Explant, coronary artery stenosis
Explant, coronary artery occlusion
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Purkinje network
Compact atrioventricular node
Conduction system
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Sinoatrial (SA) node
Sinus node fibrosis
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Rheumatic diseases and sites of involvement
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Various images
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Anterior circulation
Posterior circulation
Coronary arteries
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Venule
Various images
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Small arteriole
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MRI of the thorax showing tumor
AFIP images
arrowheads (RA-right
atrium, RV-right ventricle,
TV-tricuspid valve)
AFIP images
IAS-interatrial septum (tumors are
located inferiorly), TV-tricuspid
valve and VS-ventricular septum
filled with
proteinaceous
debris
Multiple small cysts not visible to naked eye
Cysts with irregular shape surrounded by fibrous stroma
cell lining, with inner
lining composed of
small cuboidal cells
cysts replace muscle
bundles in inferior
interatrial septum
Cuboidal cells and clear, sebaceous-type cells
Squamous differentiation and calcification of luminal debris
Nests of cells resembling urothelium
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H&E and AE1/AE3+
cyst lining of simple
cuboidal epithelium
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Pathophysiology of degeneration of valves
Potential pathways
MVP subtypes
Contributed by Aliya N. Husain, M.D.
Mitral valve
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Minimally diseased
aortic valve (left) and
severely stenotic
aortic valve (right)
Contributed by Aliya N. Husain, M.D.
Mitral valve
Aortic valve calcification
Mitral valve
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5HT signaling pathways
Heart chambers, valves, and valvular histology
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Mitral valve leaflets, Movat pentachrome stain
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Development of heart
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Medial fibroplasia
Intimal fibroplasia
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Medial fibroplasia
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GCA involving temporal artery
Halo sign
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Prominent left superficial temporal artery
Contributed by Aliya N. Husain, M.D. and AFIP
Adventitial inflammation
Chronic
inflammation with
multinucleated
giant cells
Marked intimal fibrosis
Multinucleated giant cells
Intramammary arterial lumen
Elastic stain
Fragmentation of internal elastic lamina
Elastic duplication
Normal cardiac specimen
Contributed by Melanie C. Bois, M.D.
Heart, anterior view
Heart, short axis section
Contributed by Melanie C. Bois, M.D.
Heart, microscopy
Cardiomyocytes
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Mid apical hypertrophy (arrow)
Contributed by Aliya N. Husain, M.D. and Saranya Singaravel, M.B.B.S.
Asymmetric hypertrophy
Transverse section
Contributed by Aliya N. Husain, M.D. and Saranya Singaravel, M.B.B.S.
Hypertrophied cardiomyocytes with fibrosis
Hypertrophied cardiomyocytes with focal calcifications
Hypertrophied cardiomyocytes with disarray and fibrosis
Hypertrophied cardiomyocytes with nuclear enlargement
Hypertrophied cardiomyocytes with disarray
Hypertrophied cardiomyocytes
Myocardial hypertrophy
Hypertrophied cardiomyocyte
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Myocardium
Hypertrophic cardiomyopathy
by Dr. Yuichi J. Shimada
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Echocardiographic morphological
features typical of idiopathic RCM
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men demonstrating
prominent biatrial
enlargement
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microscopy
showing marked
interstitial fibrosis
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Duke criteria for diagnosis
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Osler nodes on a finger and foot
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Large vegetation on atrial aspect of valve
Contributed by R. Amita, M.D.
Mycotic aneurysm
Dense inflammation and fibrinoid necrosis
Valve destruction with necrosis, bacterial clump
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H&E, gram stain
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MRI: acute myocarditis
Increased T2-weighted signal intensity
Echocardiograms
Gadlinium-enhanced cardiac MRI
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Pathophysiological process of viral myocarditis
Algorithm for diagnosis in suspected myocarditis
Treatment algorithm based on EMB findings
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Endomyocardial biopsy
Acute and chronic myocarditis
Contributed by Pallavi Khattar, M.D., Puneet Bedi, M.D. and John T. Fallon, M.D., Ph.D.
Papillary giant fibroelastoma of aortic valve
Contributed by Pallavi Khattar, M.D., Puneet Bedi, M.D. and John T. Fallon, M.D., Ph.D.
H&E
CD34
Elastin stain
S100
AFIP images
Finger-like projection
extending from valve
surface without branching
Contributed by Carolyn Glass, M.D., Ph.D.
Left ventricular apex with attached LVAD
LVAD pump and attachments
Overview of the HeartMate II
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Coronary artery aneurysm
Small aneurysm
Small aneurysm in thyrocervical trunk
Multiple aneurysmal changes
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Differences between NBTE and infective endocarditis
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Mitral valve with masses
Mitral valve with mass
Enlarging mitral valve mass
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Typical finding
Typical appearances
Large NBTE vegetations
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Uniform eosinophilic appearance
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Etiology of Myocarditis
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Transthoracic cardiac echocardiograms
MRI, TIRM
Pericardial effusion of 1.2 cm
MRI, IR, FLASH
Subendocardial delayed enhancement
Increased septal wall thickness
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Acute myocarditis with lymphocytic infiltration
Endomyocardial biopsy
Eosinophilic infiltration
Necrotizing eosinophilic myocarditis
Eosinophilic myocarditis
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No granulomatous inflammation
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Echocardiography
Echocardiography and MRI
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Tricuspid valve
Contributed by Melanie C. Bois, M.D.
Surgical excision
In nonaqueous medium
AFIP images
Tumor in noncoronary sinus
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Multiple small fronds resembling a sea anemone
death due to
occlusion of right
coronary ostium
Contributed by Melanie C. Bois, M.D.
Arborizing fronds
Avascular cores
AFIP images
Arising from aortic valve cusp
Movat pentachrome stain
Avascular tumor fronds growing into a cardiac chamber
Architecture obscured by scarring
Resection of large aortic valve papillary fibroelastoma
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Ventricles dilated more than atria
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Cardiomyocyte multinucleation
Adenomatous hyperplasia
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Starr-Edwards mechanical valve
Bjork-Shiley concavo-convex valve
St Jude Medical bileaflet prosthesis
Prosthetic aortic valve
Aortic prosthetic valve before & after IV heparin
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Prosthetic cardiovascular devices
AHA/ACC recommendations
Gross examination of prosthetic heart devices
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shows significant pannus
Mechanical mitral valve prosthesis
Synthetic chordae tendinae
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endocardium, native
mitral leaflet tissue
Synthetic chorda surrounded by tissue fibrosis
Segment of coronary artery
AFIP images
Right ventricular mass
with tuberous sclerosis
and multiple minute tumors
studding epicardium
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Left ventricular tumor causing sudden death in children ages 1-2
AFIP images
and intracellular
myofilaments
(oil emersion)
highlights spider
cells and cross
striations (arrowheads)
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Drawings from 1938 report
AFIP images
sparse mitochondria, fragmented
irregular myofilaments with Z bands
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Late gadolinium enhancement (LGE)
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Myocardial infiltrates
Contributed by Carolyn Glass, M.D., Ph.D.
Cardiac biopsy
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Dilated aortic root and ascending aorta
Enlarged aortic root
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Various images
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Interstitial widening in acute phase
Illustrated walkthrough of the essential features of Takotsubo cardiomyopathy
Ventricular angiography video showing the 4 main subtypes of Takotsubo cardiomyopathy
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Fibrous skeleton of heart
Aortic root structures
Mitral valve annulus
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The four heart valves
Tricuspid valve
Isolated tricuspid valve
Pulmonary valve
Mitral valve and aortic root
Mitral leaflets
Mirtal valve apparatus
Mitral valve
commissural
chordae tendinae
Aortic value, right coronary leaflet
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Tricuspid valve
Annulus of the pulmonary root
Section through the pulmonary root
Posterior mitral leaflet
Section through aortic root
IHC of aortic valves
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Annulus tissue
Commissure tissue
Arrangement of collagenous fibrils
Ashworth: 2019
Buja: 2015
Burke: 2015
Husain: 2021
IARC: 2015
Leone: 2017
Lucena: 2015
Miller: 2023
Thiene: 2016
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