title: Morphometric changes of the right ventricle in the first two weeks after clinical heart transplantation: analysis of myocardial biopsies from patients with complicated versus uncomplicated course.
abstract: OBJECTIVE
  The early phase following heart transplantation (HTx) is characterized by the development of right ventricular myocardial fibrosis (MF) and cardiomyocyte hypertrophy (CH). The question is if there are differences in development of MF and CH between patients with complicated versus patients with uncomplicated postoperative course.
  
  
  METHODS
  Endomyocardial biopsies were taken from 58 donor hearts before implantation and one and two weeks after HTx. According to the clinical course in the first year after HTx and the rejection grading (ISHLT), four groups were classified: (a) uneventful course, (b) transplant failure, (c) infections, and (d) rejection episodes > or = 1R. The volume densities of various tissue components and cardiomyocyte diameters were measured by stereological and morphometrical methods.
  
  
  RESULTS
  From implantation to the first two weeks, most groups showed a significant increase of endomysial and perimysial connective tissues. There was a significant CH recognizable, especially in the rejection group. However, nucleus surface, a hypertrophy parameter, showed no significant change during follow-up. There were no statistically significant differences in volume densities of interstitial space, capillaries, nuclei and cardiomyocytes between the collectives and points in time. Sarcomere length as marker of contraction status of cardiomyocytes remained at the same level and showed no significant differences. Demographic data showed no significant differences and will be presented.
  
  
  CONCLUSIONS
  Patients with complicated and uncomplicated courses show different degrees of histopathological changes after HTx. The extent of hypertrophy differs especially between the collectives. Measurement of endomysial connective tissue points to later postoperative course in the recipient. These findings may reflect a pattern of remodeling specific to the transplanted heart.
authors.affiliation: Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. achim_koch@med.uni-heidelberg.de
authors.forename: Achim
authors.initials: A
authors.lastname: Koch
authors.forename: Cornelius
authors.initials: C
authors.lastname: Geil-Bierschenk
authors.forename: Ralf
authors.initials: R
authors.lastname: Rieker
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Dengler
authors.forename: Falk-Udo
authors.initials: FU
authors.lastname: Sack
authors.forename: Peter
authors.initials: P
authors.lastname: Schirmacher
authors.forename: Siegfried
authors.initials: S
authors.lastname: Hagl
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Schnabel
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003238:Connective Tissue / Q000473:pathology; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000473:pathology; D016027:Heart Transplantation / Q000473:pathology*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000473:pathology; D008297:Male; D008875:Middle Aged; D032383:Myocytes, Cardiac / Q000473:pathology; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000473:pathology*; D011184:Postoperative Period