Cardiovascular Pathology
Volume 21, Issue 1 , Pages 2-16 , January 2012

Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology

  • James R. Stone

      Affiliations

    • Massachusetts General Hospital, Boston, MA, USA
    • Corresponding Author InformationCorrespondence to: James R. Stone, Massachusetts General Hospital, Simches Building Room 8236, Boston, MA, USA 02114. Tel.: +1 617 726 8303; fax: +1 617 643 3566.
  • ,
  • Cristina Basso

      Affiliations

    • University of Padua, Padua, Italy
    • Corresponding Author InformationCorrespondence to: Cristina Basso, Pathological Anatomy, Department of Medical Diagnostic, Sciences and Special Therapies, University of Padua Medical School, Via A. Gabelli 61, Padua, Italy 35121. Tel.: +39 049 8272286; fax: +39 049 8272284.
  • ,
  • Ulrik T. Baandrup

      Affiliations

    • Vendsyssel Hospital, University of Aalborg, Denmark
  • ,
  • Patrick Bruneval

      Affiliations

    • University Paris-Descartes, France
  • ,
  • Jagdish Butany

      Affiliations

    • Toronto General Hospital, Canada
  • ,
  • Patrick J. Gallagher

      Affiliations

    • Southhampton University Hospital, Southhampton, UK
  • ,
  • Marc K. Halushka

      Affiliations

    • Johns Hopkins University, Baltimore, MD, USA
  • ,
  • Dylan V. Miller

      Affiliations

    • University of Utah, Utah, USA
  • ,
  • Robert F. Padera

      Affiliations

    • Brigham and Women's Hospital, Boston, MA, USA
  • ,
  • Stanley J. Radio

      Affiliations

    • University of Nebraska, Nebraska, USA
  • ,
  • Mary N. Sheppard

      Affiliations

    • Imperial College, London, UK
  • ,
  • Kim Suvarna

      Affiliations

    • Northern General Hospital, Sheffeld, UK
  • ,
  • Carmela D. Tan

      Affiliations

    • Cleveland Clinic, Cleveland, OH, USA
  • ,
  • Gaetano Thiene

      Affiliations

    • University of Padua, Padua, Italy
  • ,
  • Allard C. van der Wal

      Affiliations

    • University of Amsterdam, Amsterdam, The Netherlands
  • ,
  • John P. Veinot

      Affiliations

    • University of Ottawa, Ottawa, Ontario, Canada

Received 19 December 2010 ,Accepted 7 January 2011.

References 

  1. Thiene G, Veinot JP, Angelini A, Baandrup UT, Basso C, Bruneval P, et al. Association for European Cardiovascular Pathology and Society for Cardiovascular Pathology Task Force on Training in Cardiovascular Pathology. AECVP and SCVP 2009 recommendations for training in cardiovascular pathology. Cardiovasc Pathol. 2010;19:129–135
  2. Caves PK, Stinson EB, Graham AF, Billingham ME, Grehl TM, Shumway NE. Percutaneous transvenous endomyocardial biopsy. J Am Med Assoc. 1973;225:288–291
  3. Sakakibara S, Konno S. Endomyocardial biopsy. Jpn Heart J. 1962;3:537–543
  4. Ferrans VJ, Roberts WC. Myocardial biopsy: a useful diagnostic procedure or only a research tool?. Am J Cardiol. 1978;41:965–967
  5. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation. 2007;116:2216–2233
  6. Fenoglio JJ. Endocardial Biopsy: Techniques and Applications. Boca Raton: CRC Press, Inc.; 1982;
  7. Cunningham KS, Veinot JP, Butany J. An approach to endomyocardial biopsy interpretation. J Clin Pathol. 2006;59:121–129
  8. Baandrup U, Florio RA, Olsen EGJ. Do endomyocardial biopsies represent the morphology of the rest of the myocardium? A quantitative light microscopic study of single v. multiple biopsies with the King's bioptome. Eur Heart J. 1982;3:171–178
  9. Billingham ME, Mason JW, Bristow MR, Daniels JR. Anthracycline cardiomyopathy monitored by morphologic changes. Cancer Treat Rep. 1978;62:865–872
  10. Basso C, Ronco F, Marcus F, Abudureheman A, Rizzo S, Frigo AC, et al. Quantitative assessment of endomyocardial biopsy in arrhythmogenic right ventricular cardiomyopathy/dysplasia: an in vitro validation of diagnostic criteria. Eur Heart J. 2008;29:2760–2771
  11. Collins AB, Smith RN, Stone JR. Classification of amyloid deposits in diagnostic cardiac specimens by immunofluorescence. Cardiovasc Pathol. 2009;18:205–216
  12. Toor AA, Ramdane BA, Joseph J, Thomas M, O'Hara C, Barlogie B, et al. Cardiac nonamyloidotic immunoglobulin deposition disease. Mod Pathol. 2006;19:233–237
  13. Calabrese F, Thiene G. Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects. Cardiovasc Res. 2003;60:11–25
  14. Magnani JW, Danik HJS, Dec GW, DiSalvo TG. Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. Am Heart J. 2006;151:463–470
  15. Cooper LT, Berry GJ, Shabetai R. Idiopathic giant cell myocarditis — natural history and treatment. N Eng J Med. 1997;336:1860–1866
  16. Kuhl U, Pauschinger M, Seeberg B, Lassner D, Noutsias M, Poller W, et al. Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation. 2005;112:1965–1970
  17. Caforio ALP, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J. 2007;28:1326–1333
  18. Kuethe F, Sigusch HH, Hilbig K, Tresselt C, Gluck B, Egerer R, et al. Detection of viral genome in the myocardium: lack of prognostic and functional relevance in patients with acute dilated cardiomyopathy. Am Heart J. 2007;153:850–858
  19. Deng MC, Eisen HJ, Mehra MR, Billingham M, Marboe CC, Berry G, et al. Noninvasive discrimination of rejection in cardiac allograft recipients using gene expression profiling. Am J Transplant. 2006;6:150–160
  20. Tan CD, Baldwin WM, Rodriguez ER. Update on cardiac transplantation pathology. Arch Pathol Lab Med. 2007;131:1169–1191
  21. Stewart S, Winters GL, Fishbein MC, Tazelaar HD, Kobashigawa J, Abrams J, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24:1710–1720
  22. Billingham ME, Cary NR, Hammond ME, Kemnitz J, Marboe C, McCallister HA, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. The International Society for Heart Transplantation. J Heart Transplant. 1990;9:587–593
  23. Smith RN, Brousaides N, Grazette L, Saidman S, Semigran M, Disalvo T, et al. C4d deposition in cardiac allografts correlates with alloantibody. J Heart Lung Transplant. 2005;24:1202–1210
  24. Gopal S, Narasimhan U, Day JD, Gao R, Kasper EK, Chen CL, et al. The Quilty lesion enigma: focal apoptosis/necrosis and lymphocyte subsets in human cardiac allografts. Pathol Int. 1998;48:191–198
  25. Michaels PJ, Espejo ML, Kobashigawa J, Alejos JC, Burch C, Takemoto S, et al. Humoral rejection in cardiac transplantation: risk factors, hemodynamic consequences and relationship to transplant coronary artery disease. J Heart Lung Transplant. 2003;22:58–69
  26. Rodriguez ER, Skojec DV, Tan CD, Zachary AA, Kasper EK, Conte JV, et al. Antibody-mediated rejection in human cardiac allografts: evaluation of immunoglobulins and complement activation products C4d and C3d as markers. Am J Transplant. 2005;5:2778–2785
  27. Mullany CJ. Aortic valve surgery in the elderly. Cardiol Rev. 2000;8:333–339
  28. Robbins RC, Stinson EB. Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg. 1996;111:586–594
  29. Allen RD, Edwards WD, Tazelaar HD, Danielson GK. Surgical pathology of subaortic septal myectomy not associated with hypertrophic cardiomyopathy: a study of 98 cases (1996–2000). Cardiovasc Pathol. 2003;12:207–215
  30. Lamke GT, Allen RD, Edwards WD, Tazelaar HD, Danielson GK. Surgical pathology of subaortic septal myectomy associated with hypertrophic cardiomyopathy. A study of 204 cases (1996–2000). Cardiovasc Pathol. 2003;12:149–158
  31. Davies MJ. The cardiomyopathies: an overview. Heart. 2000;83:469–474
  32. Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–896
  33. Rose AG, Park SJ. Pathology in patients with ventricular assist devices: a study of 21 autopsies, 24 ventricular apical core biopsies and 24 explanted hearts. Cardiovasc Pathol. 2005;14:19–23
  34. Soderlund KA, Chivukula RR, Russell SD, Conte JV, Mudd JO, Halushka MK. Prognostic value of left ventricular apical tissue removed for Heart Mate II left ventricular assist device placement. Cardiovasc Pathol. 2009;18:217–222
  35. Cazes A, Van Huyen JPD, Fornes P, Amrein C, Guillemain R, Grinda JM, et al. Mechanical ventricular assistance in heart failure: pathology of the cardiac apex removed during device implantation. Cardiovasc Pathol. 2010;19:112–116
  36. Segura AM, Frazier OH, Demirozu Z, Buja LM. Histopathologic correlates of myocardial improvement in patients supported by a left ventricular assist device. Cardiovasc Pathol (in press).
  37. Walder G, Gritsch W, Wiedermann CJ, Polzl G, Laufer G, Hotzel H, et al. Co-infection with two Chlamydophila species in a case of fulminant myocarditis. Crit Care Med. 2007;35:623–626
  38. Bruckner BA, Razeghi P, Stetson S, et al. Degree of cardiac fibrosis and hypertrophy at time of implantation predicts myocardial improvement during left ventricular assist device support. J Heart Lung Transplant. 2004;23:36–42
  39. Matsumiya G, Monta O, Fukushima N, Sawa Y, Funatsu T, Toda K, et al. Who would be a candidate for bridge to recovery during prolonged mechanical left ventricular support in idiopathic dilated cardiomyopathy?. J Thorac Cardiovasc Surg. 2005;130:699–704
  40. Angelini A, Boffa GM, Livi U, Barchitta A, Casarotto D, Thiene G. Discordance between pre and post cardiac transplant diagnosis: implications for pre- and postoperative decision making. Cardiovasc Pathol. 1999;8:17–23
  41. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113:1807–1816
  42. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, et al. Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008;29:270–276
  43. Anderson RH, Ho SY. Sequential segmental analysis — description and categorization for the millennium. Cardiol Young. 1997;7:98–116
  44. Van Praagh R. In:  Fyler DC editors. Segmental approach to diagnosis in Nadas' pediatric cardiology. Philadelphia: Hanley and Belfus; 1992;p. 27–35
  45. Basso C, Burke M, Fornes P, Gallagher PJ, Henriques de Gouveia R, Sheppard M, et al. Association for European Cardiovascular Pathology. Guidelines for autopsy investigation of sudden cardiac death. Virchows Arch. 2008;452:11–18
  46. Edwards WD. Cardiovascular system. In:  Ludwig J,  Totowa NJ editor. Handbook of autopsy practice. 3rd ed. Humana Press; 2002;p. 21–43
  47. Bradshaw SH, Kennedy L, Dexter DF, Veinot JP. A practical method to rapidly dissolve metallic stents. Cardiovasc Pathol. 2009;18:127–133
  48. Patel J, Sheppard MN. Pathological study of primary cardiac and pericardial tumours in a specialist UK centre: surgical and autopsy series. Cardiovasc Pathol. 2010;19:343–352
  49. Basso C, Valente M, Poletti A, Casarotto D, Thiene G. Surgical pathology of primary cardiac and pericardial tumors. Eur J Cardiothorac Surg. 1997;12:730–737
  50. Burke AP, Cowan D, Virmani R. Primary sarcomas of the heart. Cancer. 1992;69:387–395
  51. Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol. 1997;80:671–682
  52. Luk A, Nwachukwu H, Lim K-D, Cusimano RJ, Butany J. Cardiac angiosarcoma: a case report and review of the literature. Cardiovasc Pathol. 2010;19:e69–e74
  53. Butany J, Nair V, Naseemuddin A, Nair GM, Catton C, Yau T. Cardiac tumours: diagnosis and management. Lancet Oncol. 2005;6:219–228
  54. Winther C, Timmermans-Wielenga V, Daugaard S, Mortensen SA, Sander K, Andersen CB. Primary cardiac tumors: a clinicopathologic evaluation of four cases. Cardiovasc Pathol. 2011;20:63–67
  55. Travis WD, Brambilla E, Muller-Hermelink H, Harris CC. World Health Organization Classification of Tumors. Pathology and genetics. Tumours of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004;
  56. Terracciano LM, Mhawech P, Suess K, D’Armiento M, Lehmann FS, Jundt G, et al. Calretinin as a marker for cardiac myxoma, diagnostic and histogenetic considerations. Am J Clin Pathol. 2000;114:754–759
  57. Harrison DC, Isaeff DM, Debusk RF. Papillary muscle syndromes. Dis Mon. 1972;3–48
  58. Connelly JH, Clubb FJ, Vaughn W, Duncan M. Morphological changes in atrial appendages removed during the maze procedure: a comparison with autopsy controls. Cardiovasc Pathol. 2001;10:39–42
  59. Saito T, Tamura K, Uchida D, Saito T, Togashi M, Nitta T, et al. Histopathological features of the resected left atrial appendage as predictors of recurrence after surgery for atrial fibrillation in valvular heart disease. Circ J. 2007;71:70–78
  60. Rocken C, Peters B, Juenemann G, Saeger W, Klein HU, Huth C, et al. Atrial amyloidosis. Circulation. 2002;106:2091–2097
  61. Oh KY, Shimizu M, Edwards WD, Tazelaar HD, Danielson GK. Surgical pathology of the parietal pericardium: a study of 344 cases (1993-1999). Cardiovasc Pathol. 2001;10:157–168
  62. Little WC, Freeman GL. Pericardial disease. Circulation. 2006;113:1622–1632
  63. Seferovic PM, Spodick DH, Maisch B. Pericardiology: Contemporary answers to continuing challenges. Belgrade: Science, 2000.
  64. Rojo-Leyva F, Ratliff NB, Cosgrove DM, Hoffman G. Study of 52 patients with idiopathic aortitis from a cohort of 1,204 surgical cases. Arthritis Rheumatism. 2000;43:901–907
  65. Homme JL, Aubry MC, Edwards WD, Bagniewski SM, Pankratz VS, Kral CA, et al. Surgical pathology of the ascending aorta: a clinicopathologic study of 513 cases. Am J Surg Pathol. 2006;30:1159–1168
  66. Nesi G, Anichini C, Tozzini S, Boddi V, Calamai G, Gori F. Pathology of the thoracic aorta: a morphologic review of 338 surgical specimens over a 7-year period. Cardiovasc Pathol. 2009;18:134–139
  67. Jain D, Dietz HC, Oswald GL, Maleszewski JJ, Halushka MK. Causes and histopathology of ascending aortic disease in children and young adults. Cardiovasc Pathol. 2011;20:15–25
  68. Burke AP, Virmani R. Sarcomas of the great vessels. A clinicopathologic study. Cancer. 1993;71:1761–1773
  69. Stone JH, Khosroshahi A, Deshpande V, Stone JR. IgG4-related systemic disease accounts for a significant proportion of thoracic lymphoplasmacytic aortitis cases. Arthrit Care Res. 2010;62:316–322
  70. Allsop CJ, Gallagher PJ. Temporal artery biopsy in giant-cell arteritis: a reappraisal. Am J Surg Pathol. 1981;5:317–323
  71. Klein RG, Campbell RJ, Hunder GG, Carney JA. Skip lesions in temporal arteritis. Mayo Clin Proc. 1976;51:504–510
  72. Albert DM, Ruchman MC, Keltner JL. Skip areas in temporal arteritis. Arch Ophthalmol. 1976;94:2072–2077
  73. Chakrabarty A, Franks AJ. Temporal artery biopsy: is there any value in examining biopsies at multiple levels?. J Clin Pathol. 2000;53:131–136
  74. Font RL, Prabhakaran VC. Histological parameters helpful in recognizing steroid-treated temporal arteritis: an analysis of 35 cases. Br J Ophthalmol. 2007;91:204–209
  75. Gooi P, Brownstein S, Rawlings N. Temporal arteritis: a dilemma in clinical and pathological diagnosis. Can J Ophthalmol. 2008;43:119–120
  76. Churchill CH, Abril A, Krishna M, Callman ML, Ginsburg WW. Jaw claudication in primary amyloidosis: unusual presentation of a rare disease. J Rheumatol. 2003;30:2283–2286
  77. Luscher TF, Lie JT, Stanson AW, Houser OW, Hollier LH, Sheps SG. Arterial fibromuscular dysplasia. Mayo Clin Proc. 1987;62:931–952
  78. Leu HJ, Lie JT. Diseases of the veins and lymphatic vessels, including angiodysplasia.. In:  Stehbens WE,  Lie JT editor. Vascular Pathology. London: Chapman & Hall; 1995;p. 489–516
  79. Kapadia MR, Popowich DA, Kibbe MR. Modified prosthetic vascular conduits. Circulation. 2008;117:1873–1882
  80. Verzini F, Cao P, De Rango P, Parlani G, Xanthopoulos D, Iacono G, et al. Conversion to open repair after endografting for abdominal aortic aneurysm: causes, incidence and results. Eur J Vasc Endovasc Surg. 2006;31:136–142
  81. Hermanns B, Janssens U, Handt S, Fuzesi L. Pathomorphological aspects of heparin-induced thrombocytopenia II (HIT-II syndrome). Virchows Archiv. 1998;432:541–546
  82. Calabrese F, Carturan E, Thiene G. Cardiac infections: focus on molecular diagnosis. Cardiovasc Pathol. 2010;19:171–182
  83. Schoen FJ. Approach to the analysis of cardiac valve prostheses as surgical pathology or autopsy specimens. Cardiovasc Pathol. 1995;4:241–255
  84. Lee JH, Burner KD, Fealey ME, Edwards WD, Tazelaar HD, Orszulak TA, et al. Prosthetic valve endocarditis: clinicopathological correlates in 122 surgical specimens from 116 patients (1985–2004). Cardiovasc Pathol. 2011;20:26–35
  85. Padera RF. Pathology of cardiac assist devices. In:  McManus BM,  Braunwald E editor. Atlas of cardiovascular pathology for the clinician. 2nd ed.. New York: Springer; 2008;p. 257–273

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PII: S1054-8807(11)00006-8

doi: 10.1016/j.carpath.2011.01.001

Cardiovascular Pathology
Volume 21, Issue 1 , Pages 2-16 , January 2012