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DOI: 10.1055/s-0032-1332360
Myocardial remodeling with and without VAD support – a case report of siblings
Introduction: Support of a failing heart by ventricular assist devices (VAD) causes myocardial remodeling. The elucidation of these processes is hindered by major interindividual differences between patients. We compare two brothers with hereditary dilated cardiomyopathy. One underwent heart transplantation (HTX) after VAD support for 6 months, the other without temporary mechanical assistance on high urgency status.
Methods: Specimens of the left ventricle were subjected to haematoxylin eosin (HE) and Elastica van Gieson (EvG) staining and were examined for expression of Ki 67 (DAKO), Prox-1 (Acris), and connexin-43 (Cx43, Sigma) using immunohistochemical techniques.
Results: Both patients needed therapy at the age of 44 years. Renal function was normal (creatinine, 1.1 – 1.2 mg/dl) and C-reactive protein amounted to 15 – 19 mg/l before each operation. EvG staining indicated diffuse myocardial fibrosis after VAD support. The native heart samples showed also fibrotization, however, less pronounced. Diffuse infiltration with regional accentuation was observed in the mechanically supported heart, but not in native myocardium in HE stainings. Further, the gap junction protein Cx43 exhibited strong expression in the myocardium after support, whereas expression was not detectable before VAD implantation. Positive Cx43 staining was also observed in the native explanted heart, but less marked than in the supported heart. No differences between the samples were observed for the proliferation marker Ki67 and the lymphangiogenesis marker Prox-1.
Conclusion: The same genetic background in two patients with dilated cardiomyopathy allows for close comparison of myocardial remodeling with and without mechanical support. Differences were observed with regard to fibrotization and to the electrical conductive system.