DIAGNOSIS OF CARDIAC THROMBOSIS IN PATIENTS WITH ATRIAL-FIBRILLATION IN THE ABSENCE OF MACROSCOPICALLY VISIBLE THROMBI
DIAGNOSIS OF CARDIAC THROMBOSIS IN PATIENTS WITH ATRIAL-FIBRILLATION IN THE ABSENCE OF MACROSCOPICALLY VISIBLE THROMBI
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DOI：
10.1007/bf01605135
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发表时间：
1993-01-01
期刊：
影响因子：
--
通讯作者：
OONEDA, G
中科院分区：
文献类型：
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作者：
MASAWA, N;YOSHIDA, Y;OONEDA, G
心房颤动（AF）引起的心脏血栓形成已被认为是脑栓塞的最常见原因。然而，有时在这种类型的脑栓塞的受害者的心脏中尸检时没有发现肉眼可见的血栓。本文对31例（其中房颤21例）脑栓塞死亡患者的左房内膜进行了形态学观察。肉眼观察到的“粗糙心内膜”（RE）为存在心房血栓形成提供了证据。AF病例中出现的RE是由于与水肿和纤维增厚相关的内膜颗粒状和褶皱外观。纤维蛋白丝沉积物也总是可区分的。镜下见壁血栓、水肿伴内膜下中性粒细胞浸润。扫描电子显微镜（SEM）通常观察到小面积的内皮剥脱和血栓性聚集。这些SEM病变在AF患者中的发生率明显高于对照组（P < 0.001）。当增加RE区域的组织学检查证实的血栓时，AF病例中心房血栓形成的诊断成功率从33.3%增加到81%。当尸检时肉眼观察无法检测到血栓形成时，左心房RE可能是房颤心房血栓形成的解剖学相关发现。
Cardiac thrombosis due to atrial fibrillation (AF) has been recognized as the most common cause of cerebral embolism. However, sometimes no macroscopic thrombus is found at autopsy in the heart of a victim of this type of cerebral embolism. We investigated morphological changes in the left atrial endocardium of 31 patients (including 21 cases with AF) who had died of cerebral embolism. ''Rough endocardium'' (RE) seen macroscopically provided evidence for the existence of atrial thrombosis. The RE that appeared in AF cases was due to a granular and wrinkled appearance of the endocardium associated with oedematous and fibrous thickening. Fibrin-thread deposits were also always distinguishable. Mural thrombi and oedema with neutrophil infiltration in the subendocardium could be seen under the microscope. Small areas of endothelial denudation and thrombotic aggregations were commonly observed by scanning electron microscopy (SEM). These SEM lesions were significantly more frequent in cases with AF than in controls (P < 0.001). The diagnostic success rate for atrial thrombosis among cases with AF increased from 33.3% to 81% when thrombi proven by histological investigation of the areas with RE were added. Left atrial RE may be an anatomically relevant finding for the existence of atrial thrombosis with AF, when the thrombosis cannot be detected upon gross observation at autopsy.