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Virchows Archiv
Published in: Virchows Archiv 6/2014

01-06-2014 | Review and Perspectives

Coronary cardiac allograft vasculopathy versus native atherosclerosis: difficulties in classification

Authors: Annalisa Angelini, Chiara Castellani, Marny Fedrigo, Onno J. de Boer, Lorine B. Meijer-Jorna, Xiaofei Li, Marialuisa Valente, Gaetano Thiene, Allard C. van der Wal

Published in: Virchows Archiv | Issue 6/2014

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Abstract

Cardiac allograft vasculopathy is regarded as a progressive and diffuse intimal hyperplastic lesion of arteries and veins that leads to insidious vessel narrowing and to allograft ischemic disease, such as acute myocardial infarction or sudden cardiac death. The coronary lesions in transplanted hearts are considered as a particular type of arteriosclerosis with many similarities but also significant differences compared to native coronary atherosclerosis. It is particularly difficult for pathologists to systematically classify the lesions and to elucidate their origins, since over time, the allograft immune responses cause vascular pathology characterized by not only the onset of de novo fibrocellular lesions but also remodeling of already-existing native atherosclerotic lesions in the donor heart. Intraplaque hemorrhages, which result from newly formed leaky microvessels, may cause rapid increase of stenosis and generate a substrate for plaque destabilization. Comparing cardiac allograft vasculopathy from explanted hearts at autopsy with native coronary atherosclerosis from hearts removed at transplantation has revealed that ongoing intraplaque hemorrhages are also an important feature of cardiac allograft vasculopathy and may be important factors in the rapid progression of cardiac allograft vasculopathy.
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Metadata
Title
Coronary cardiac allograft vasculopathy versus native atherosclerosis: difficulties in classification
Authors
Annalisa Angelini
Chiara Castellani
Marny Fedrigo
Onno J. de Boer
Lorine B. Meijer-Jorna
Xiaofei Li
Marialuisa Valente
Gaetano Thiene
Allard C. van der Wal
Publication date
01-06-2014
Publisher
Springer Berlin Heidelberg
Published in
Virchows Archiv / Issue 6/2014
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI
https://doi.org/10.1007/s00428-014-1586-6

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