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Shah S, Yadav R, Yadav S, Khanal R, Poudel CM. A rare case of atrial and biventricular thrombi with dilated cardiomyopathy as a delayed presentation in a patient with COVID-19. Ann Med Surg (Lond) 2022; 79:104057. [PMID: 35818400 PMCID: PMC9259012 DOI: 10.1016/j.amsu.2022.104057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Coronavirus 2019 (COVID-19) can cause cardiovascular manifestations including myocardial injury and thromboembolic events. Case presentation Here, we report a case of a 27-year-old female with dilated cardiomyopathy, right atrial and biventricular thrombi infected with COVID-19. Discussion There are several complex coagulation abnormalities in COVID-19 patients that have been suggested to create a hypercoagulable state. Evidence have shown that endothelial injury potentially leading to thromboembolic events is caused by direct invasion of endothelial cell by SARS-CoV-2 and complement activation contributed by the virus spike protein. Conclusion DCM can be complicated by atrial and biventricular thrombi due to coagulation abnormalities that are likely to persist after recovery from COVID-19. Thus, long-term careful monitoring of cardiac function is necessary after recovery of COVID-19. DCM can be complicated by atrial and biventricular thrombi due to coagulation abnormalities. Long-term careful monitoring of cardiac function is necessary after recovery of COVID-19.
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Sonaglioni A, Albini A, Nicolosi GL, Rigamonti E, Noonan DM, Lombardo M. Case Report: An Unusual Case of Biventricular Thrombosis in a COVID-19 Patient With Ischemic Dilated Cardiomyopathy: Assessment of Mass Mobility and Embolic Risk by Tissue Doppler Imaging. Front Cardiovasc Med 2021; 8:694542. [PMID: 34395561 PMCID: PMC8358798 DOI: 10.3389/fcvm.2021.694542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein binds to angiotensin-converting enzyme 2 (ACE2) receptor on vascular cells. As a consequence, patients with COVID-19 have an increased incidence of thromboembolic complications of the SARS-CoV-2 infection and subsequent endothelial cell damage with consequence of development of systemic vasculitis and diffuse intravascular coagulation. The present case describes a COVID-19 female patient with ischemic dilated cardiomyopathy, who presented with congestive heart failure and echocardiographic evidence of biventricular apical thrombi. The peak antegrade longitudinal velocity (Va) of each thrombotic mass was measured by pulsed wave tissue Doppler imaging (PW-TDI). Both left ventricular and right ventricular apical thrombi were found with a TDI-derived mass peak Va < 10 cm/s. There was no clinical evidence of neither systemic nor pulmonary embolization, probably due to the hypomobility of both left and right ventricular masses.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | - Adriana Albini
- Scientific and Technological Pole, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | | | - Elisabetta Rigamonti
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | - Douglas M Noonan
- Scientific and Technological Pole, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Michele Lombardo
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
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Kammari CB, Rallabandi S, Rallabandi H, Daggubati SR, Adapa S, Naramala S, Konala VM. Case Report: Dilated cardiomyopathy with biventricular thrombus secondary to impaired coagulation in a patient with HIV. F1000Res 2020; 9:610. [PMID: 32704356 PMCID: PMC7361504 DOI: 10.12688/f1000research.24016.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 11/27/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection is a known hypercoagulable state with venous thromboembolism with a high mortality rate compared to the general population. The homeostatic balance in HIV infected patients improves with treatment compared to those who are not. A decreased hypercoagulable state noted by low levels of Von Willebrand factor, factor VIII and d-dimer levels along with higher protein C and S activity in patients on treatment suggests that hypercoagulable state is partially correctable with highly active antiretroviral therapy. HIV with heart muscle involvement can present as myocarditis or as dilated cardiomyopathy with left or right ventricular dysfunction. Here we present a case of a 57-year-old man with a known history of HIV infection, noncompliant with medical therapy presenting with dilated cardiomyopathy with biventricular thrombi with reduced protein C, protein S, and Antithrombin III levels.
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Affiliation(s)
- Chetan Brahma Kammari
- Department of Internal Medicine, Cape Fear Valley Hospital, Fayetteville, NC, 28304, USA
| | - Suhasini Rallabandi
- Department of Internal Medicine, Mery Hospital Joplin, Joplin, MO, 64804, USA
| | | | | | - Sreedhar Adapa
- Department of Internal Medicine, Division of Nephrology, Kaweah Delta Medical Center, Visalia, CA, 93291, USA
| | - Srikanth Naramala
- Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, CA, 93230, USA
| | - Venu Madhav Konala
- Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, KY, 41101, USA
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4
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Ghassemi A, Bharadia J, Liu A. Acute renal infarction, transient ischemic attack, and biventricular thrombi secondary to substance use disorder: A case report. Clin Case Rep 2019; 7:861-864. [PMID: 31110704 PMCID: PMC6509887 DOI: 10.1002/ccr3.2101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/27/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022] Open
Abstract
Cocaine is the second most used illicit drug; cocaine induces platelet activation and formation of thrombus. Thrombotic effects of cocaine can lead to vascular injuries, cerebrovascular accident and myocardial infarct. Less common, cocaine use disorder leads to thrombi formation in both ventricles and renal artery infarct as seen in our patient.
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Affiliation(s)
- Azadeh Ghassemi
- Department of NeurologyCalifornia Hospital Medical CenterLos AngelesCalifornia
- Ross University School of MedicineMiramarFlorida
| | - Juma Bharadia
- Department of CardiologyCalifornia Hospital Medical CenterLos AngelesCalifornia
| | - Antonio Liu
- Department of NeurologyCalifornia Hospital Medical CenterLos AngelesCalifornia
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5
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Iwano T, Yunoki K, Tokunaga N, Shigetoshi M, Sugiyama H, Yamamoto H, Kondo J, Nakai M, Okada M, Matsubara H. A case of biventricular thrombi in a patient with dilated cardiomyopathy: Utility of multimodality imaging for diagnosis and management of treatment strategy. J Cardiol Cases 2016; 15:91-94. [PMID: 30279748 DOI: 10.1016/j.jccase.2016.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/05/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022] Open
Abstract
A 54-year-old man was transferred to our hospital due to congestive heart failure and left ventricular thrombi. Transthoracic echocardiography (TTE) showed mobile "ball-like" not only left ventricular but also right ventricular thrombi associated with severe impaired left and right ventricular function. Contrast-enhanced computed tomography (CT) and cardiac magnetic resonance imaging (MRI) also detected biventricular apical thrombi complicated with right renal infarction. Coronary angiography showed non-significant stenosis. Due to the mobility of thrombi and complication of systemic infarction, the surgical transatrial video-assisted removal of biventricular thrombi was performed and postoperative course has been uneventful over a period of 6 months. Endomyocardial biopsy performed during an operation showed no specific findings such as endomyocarditis, indicating the diagnosis of dilated cardiomyopathy (DCM). This is a rare case of DCM complicated with biventricular apical thrombi detected clearly by multimodality imaging such as TTE, contrast-enhanced CT and cardiac MRI, and surgical removal was performed successfully. <Learning objective: The incidence of biventricular thrombi is rare and has been reported to be associated with coagulation abnormality and severe ventricular dysfunction. The detection of ventricular thrombi using echocardiography is sometimes difficult, and treatment strategy often becomes a major topic of debate. The usefulness of multimodality imaging for the detection of ventricular thrombi leads to accurate diagnosis and provides helpful information regarding the selection of appropriate treatment.>.
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Affiliation(s)
- Takayuki Iwano
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Kei Yunoki
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Noriyuki Tokunaga
- Department of Cardiovascular Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Masataka Shigetoshi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hiroki Sugiyama
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Hiroyuki Yamamoto
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Jun Kondo
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Mikizo Nakai
- Department of Cardiovascular Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Masahiro Okada
- Department of Cardiovascular Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan.,Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
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6
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Nkoke C, Kuate LM, Luchuo EB, Edie SD, Boombhi J, Menanga A. Biventricular thrombi in dilated cardiomyopathy in a patient with human immunodeficiency virus infection: a case report. BMC Res Notes 2015; 8:168. [PMID: 25927981 PMCID: PMC4416286 DOI: 10.1186/s13104-015-1140-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa is undergoing epidemiological transition with an increase in the prevalence of cardiovascular diseases that will add to the already devastating burden of infectious diseases such as human immunodeficiency virus infection. Human immunodeficiency virus infection is increasingly being recognized as an important etiological factor for dilated cardiomyopathy with the potential complication of intraventricular thrombus. However, biventricular thrombi are extremely rare. We report on a rare finding of biventricular thrombi in dilated cardiomyopathy in a patient with human immunodeficiency virus infection in Cameroon. CASE PRESENTATION A 52-year old Cameroonian male patient with human immunodeficiency virus infection since 4 years, longstanding heavy alcohol consumption and cigarette smoking presented with gradually worsening shortness of breath, fatigue, persistent dry cough and lower extremity swelling of about two weeks duration. Congestive heart failure was diagnosed. Echocardiography showed left ventricular chamber enlargement with severe left ventricular systolic dysfunction and biventricular thrombi. The thrombi were immobile and regular in configuration, suggesting they were old. He was treated with a conventional heart failure treatment including loop diuretics and angiotensin converting enzyme inhibitors and anticoagulants for the biventricular thrombi. Six months later, a control echocardiography showed a significant decrease in the size of the thrombi. There was no evidence of systemic or pulmonary embolization during follow up. CONCLUSION Dilated cardiomyopathy may be seen in patients with human immunodeficiency virus infection, although other mechanisms needs to be assessed, but the occurrence of biventricular thrombi is rare.
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Affiliation(s)
- Clovis Nkoke
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | | | - Engelbert Bain Luchuo
- Centre for Population Studies and Health Promotion, CPSHP, Yaounde, Cameroon. .,Department of Military Health, Ministry of Defense, Yaounde, Cameroon.
| | - Sandrine Dikosso Edie
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - Jerome Boombhi
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - Alain Menanga
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
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Egashira T, Murata M, Yasuda R, Suzuki K, Tsuruta H, Akaishi M, Fukuda K. Three-dimensional echocardiography findings of biventricular thrombi complicated by cerebral embolism. J Echocardiogr 2011; 9:163-4. [PMID: 27277299 DOI: 10.1007/s12574-011-0099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 07/12/2011] [Accepted: 07/22/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Toru Egashira
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Mitsushige Murata
- Department of Laboratory Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Risako Yasuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Keiko Suzuki
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Makoto Akaishi
- Department of Cardiology, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
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Haine SE, De Ridder SM, Van de Vijver KK. Images in cardiology. Ventricular thrombi with pulmonary and systemic embolization. Can J Cardiol 2008; 24:e92. [PMID: 18987770 DOI: 10.1016/s0828-282x(08)70205-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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9
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Paç FA, Cağdaş DN. Treatment of massive cardiac thrombi in a patient with protein C and protein S deficiency. Blood Coagul Fibrinolysis 2007; 18:699-702. [PMID: 17890961 DOI: 10.1097/mbc.0b013e3282eff788] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myocarditis and dilated cardiomyopathy is characterized by dilatation of all four cardiac chambers and decreased systolic function of the heart, especially in the left ventricle. In this report we presented a patient with myocarditis or dilated cardiomyopathy and deficiency of protein C and protein S with biventricular multiple intracardiac thrombi. Standard heparin infusion and acetyl salicylic acid was begun. On the 10th day of hospitalization the right ventricular thrombus disappeared, and on the 24th day all thrombi in the left ventricle disappeared. During the treatment we did not observe any complication such as hemorrhagia or embolism. We think that patients with dilated cardiomyopathy or myocarditis should be evaluated for hemostatic disorders, and should be anticoagulated if any of these disorders are presented.
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Affiliation(s)
- F Ayşenur Paç
- Yuksek Ihtisas Education and Research Hospital, Section of Pediatric Cardiology, Ankara, Turkey
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10
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Kozdag G, Ciftci E, Vural A, Selekler M, Sahin T, Ural D, Kahraman G, Agacdiken A, Demirci A, Komsuoglu S, Komsuoglu B, Fici F. Silent cerebral infarction in patients with dilated cardiomyopathy: Echocardiographic correlates. Int J Cardiol 2006; 107:376-81. [PMID: 15913815 DOI: 10.1016/j.ijcard.2005.03.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 03/16/2005] [Accepted: 03/26/2005] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with dilated cardiomyopathy (DCM) have an increased risk of thromboembolic events. Incidence of silent cerebral infarction (SCI) has not been investigated in these patients. The aim of this study was to investigate the incidence of SCI in patients with DCM and to determine its associations with echocardiographic parameters. METHODS AND RESULTS Seventy-two patients (mean age 62+/-12 years) with DCM underwent cranial magnetic resonance imaging in addition to transthoracic and transesophageal echocardiographic examination. A total of 56 age-matched healthy volunteers served as a control group for comparison SCI prevalence. Prevalence of SCI was significantly higher in patients with DCM (35% vs. 3.6%; p<0.001). In DCM group, patients with SCI had significantly impaired left ventricular systolic function, higher frequency of restrictive diastolic filling, moderate to severe left atrial spontaneous echo contrast (SEC), aortic SEC, and complex atherosclerosis or calcified plaques in the aorta. In logistic regression analysis, type of diastolic filling emerged as the only independent risk factor for SCI (p<0.001). When the type of diastolic filling was removed from the analysis, ejection fraction, marked left atrial SEC, complex-calcified aortic atheroma and age appeared as the other independent risk factors (p = 0.003, p = 0.009, p = 0.013 and p = 0.018, respectively). CONCLUSION SCI is a frequent finding in DCM patients. Impaired systolic function, restrictive filling pattern, presence of moderate to severe left atrial SEC, and complex atherosclerosis in the aorta are the factors contributing to the development of SCI.
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Affiliation(s)
- Guliz Kozdag
- Kocaeli University Medical Faculty, Cardiology, Kocaeli, Turkey.
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11
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Hsu CH, Chao TH, Tsai WC, Li WT, Liu PY, Lin LJ, Chen JH, Tsai LM. CASE REPORTS: Intracardiac Thrombosis in Multiple Chambers and Descending Aorta Manifested as Systemic and Pulmonary Thromboembolism. Echocardiography 2005; 22:671-4. [PMID: 16174121 DOI: 10.1111/j.1540-8175.2005.40039.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report a case with multiple thrombosis that underwent sudden circulatory collapse due to acute pulmonary embolism and ischemic stroke. Further confirmed by transesophageal echocardiography, the thrombus in both atria was detected by transthoracic echocardiography. In addition, patent foramen ovale and another thrombus in the descending aorta were readily identified by transesophageal echocardiography. Aspirin was prescribed and thrombi disappeared 1 month later. Our case report suggests that patients undergoing sudden collapse with unexplained hypoxemia and new neurological deficit secondary to coexistence of pulmonary and systemic embolism should be promptly evaluated by echocardiography, especially transesophageal one, with high suspicion for paradoxical embolism.
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Affiliation(s)
- Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, National Cheng-Kung University Medical Center, Tainan, Taiwan.
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Bankl HC, Grossschmidt K, Pikula B, Bankl H, Lechner K, Valent P. Mast cells are augmented in deep vein thrombosis and express a profibrinolytic phenotype. Hum Pathol 1999; 30:188-94. [PMID: 10029447 DOI: 10.1016/s0046-8177(99)90274-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A number of recent data suggest that mast cells (MC) and their products are involved in the pathophysiology of thrombosis. In the current study, we have evaluated the number, distribution, and phenotype of MC in patients with deep vein thrombosis of the lower limb (DVT) (n = 15). Contralateral nonthrombosed limb veins served as control (CO). MC were examined by Giemsa staining and by immunohistochemistry using antibodies against tryptase, chymase, tissue-type plasminogen activator (tPA), urokinase (uPA), urokinase receptor (uPAR), and plasminogen activator inhibitors (PAI-1, PAI-2). We found an increase in the number of tryptase-positive MC in DVT compared with CO (DVT: 9.1+/-1.0 v CO: 4.7+/-0.6 MC/mm2, P < .05). Most of these MC appeared to accumulate in the adventitia of the thrombosed veins, in vicinity of the vasa vasorum. In both DVT and CO, MC reacted with monoclonal antibodies to c-kit, tryptase, and chymase. MC also stained positive for tPA and urokinase receptor, but did not express detectable PAI-1 or PAI-2. As compared with CO, a decreased proportion of MC in DVT was found to stain positive for chymase and tPA. Together, our results show that MC increase in number in DVT and express a profibrinolytic phenotype. We hypothesize that MC and MC-derived profibrinolytic molecules play a role in the pathophysiology of DVT.
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Affiliation(s)
- H C Bankl
- Department of Internal Medicine I, Embryological Institute, University of Vienna, Austria
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Bankl HC, Radaszkiewicz T, Pikula B, Baghestanian M, Mehrabi MR, Bankl H, Lechner K, Valent P. Expression of fibrinolytic antigens in redistributed cardiac mast cells in auricular thrombosis. Hum Pathol 1997; 28:1283-90. [PMID: 9385934 DOI: 10.1016/s0046-8177(97)90202-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent data suggest that auricular thrombosis is associated with an increase and accumulation of mast cells (MC) in the subendothelial region of the upper endocardium. However, the molecular basis and the functional role of MC in this process are not known. In the current study, expression of fibrinolytic and antifibrinolytic antigens in human cardiac MC was analyzed by immunohistochemistry. MC were found to react with antibodies against tissue-type plasminogen activator (tPA) and urokinase receptor (uPAR/CD87), but not with antibodies against urokinase (uPA) or plasminogen activator inhibitors (PAI-1, PAI-2). Significant changes were observed when the phenotype of accumulated MC in the upper endocardium in patients with auricular thrombosis was compared with the phenotype of myocardial MC in the same patients or with MC in normal hearts. These redistributed MC stained less intensely with antibodies against tPA and chymase but retained their staining for tryptase and uPAR. Together, these data indicate that cardiac MC are a source of fibrinolytic antigens and that accumulation of MC in auricular thrombosis is associated with phenotypic changes of MC and loss of cellular tPA. It is hypothesized that MC and their products may play a role in endogenous fibrinolysis in auricular thrombosis.
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Affiliation(s)
- H C Bankl
- Department of Internal Medicine I, University of Vienna, Austria
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Abstract
We present a case of diabetic nephrotic syndrome complicated with cerebral embolism in whom two intracardiac thrombi were found in both right and left ventricles without obvious abnormality echocardiographically. Both thrombi regressed after anticoagulant therapy. This represents an intracardiac thrombotic complication of nephrotic syndrome, presumably with hypercoagulable state as the sole mechanism of intracardiac thrombus formation.
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Affiliation(s)
- T Y Huang
- Department of Medicine, Chi Mei Foundation Hospital, Tainan, Taiwan, R.O.C
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