Post-mortem angiographic and histologic findings of coronary artery fibromuscular dysplasia

Nerantzis, Christos E.; Kalogrias, Nikos F.; Letsas, Κonstantinos P.; Gavrielatos, Gerasimos; Salachas, Anastasios; Antonellis, Ioannis P.; Koutsaftis, Philips N.

doi:10.1016/j.ijcard.2007.06.149

Cited by 11 publications

(10 citation statements)

References 16 publications

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“…In the first autopsy report of coronary FMD, affected segments were severely thickened by intimal and medial hyperplasia and fibrosis, along with adventitial proliferation of collagen, which caused severe obliteration of lumen (14). These pathological abnormalities might manifest in the coronary arteries as the classic string-of-beads appearance (rare) (23) or as diffuse tubular stenosis in mid-distal vessels (might be due to obliterative disease, dissection, or healed dissection) (6,26,27), or more likely as "normal" (subsequently labeled as microvascular disease). The internal elastic lamina can be disrupted, duplicated, or practically absent in severely affected coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Coronary Artery Dissection

Saw

Ricci

Starovoytov

et al. 2013

JACC: Cardiovascular Interventions

351

119

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Section: Discussionmentioning

confidence: 99%

Spontaneous Coronary Artery Dissection

Saw

Ricci

Starovoytov

et al. 2013

JACC: Cardiovascular Interventions

351

119

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“…Whatever the underlying mechanism, the results maybe point to a significant narrowing of the lumen of the affected arteries, which finally leads to a reduction in blood flow and dysfunction of the PM and the valves supported by them. FMD can affect heart arteries from a few millimetres to 45 mm in length (James 1990;Lee et al 2000;Nerantzis et al 2002Nerantzis et al , 2003Nerantzis et al , 2007. Table 1 shows the different degrees of replacement of smooth muscle cells of the PM arteries by fibrous tissue (subgroups, A, B, C) in relation to age expressed in decades.…”

Section: Discussionmentioning

confidence: 99%

Age-related fibromuscular dysplasia in the human left ventricle papillary muscles arteries

Nerantzis¹,

Karakoukis²,

Lernia³

et al. 2016

Anat Sci Int

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We describe histologically cases of patients between 31 and 60 years of age who had fibromuscular dysplasia (FMD) in the tunica media (TM) of the left ventricle papillary muscles (PM) arteries. We also compared them with our previous findings in subjects younger than 30 years of age. We examined histologically samples taken from the tip of the anterior PM of the left ventricle in 200 healthy male hearts. In 33 cases (16.5 %), FMD was in the TM. We divided these cases into three subgroups (A, B, C) based on the degree of replacement of smooth muscle cells by fibrous tissue, and thus identified 17, 11 and 5 cases, respectively. Until the age of 41, the typical lesions were often localized within the TM. Beyond that age, the fibrous tissue increased in the TM wall and in the surrounding area of the vessels, causing dysfunction of the PM. Degenerative lesions, as well as inflammatory infiltration, were found after the age of 53. The findings of this study will be useful to cardiologists and cardiac surgeons, in pointing out that, after the age of 44 years old, some PM and their supporting valves may present a degree of dysfunction.

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“…There are isolated case reports of FMD manifesting with a “string of beads” appearance of the coronary arteries; however, in the few articles describing this, the “beading” does not have the characteristic appearance of that seen in noncoronary FMD and probably represents another angiographic appearance of dissection (27,28). The appearance of distal tapering or long, smooth narrowing in the middle of the artery may also represent dissection or intramural hematoma (Figure 5) (11,26,36). Lesions are usually well demarcated on angiography, with a discrete transition from normal to diseased coronary artery (Figure 5) (3,11).…”

Section: Diagnosismentioning

confidence: 99%

Coronary Artery Manifestations of Fibromuscular Dysplasia

Michelis

Olin

Kadian-Dodov

et al. 2014

Journal of the American College of Cardiology

123

105

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Fibromuscular dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic “string of beads” that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramural hematoma, spasm, or tortuosity. Importantly, FMD must be identified in at least one other noncoronary arterial territory to attribute any coronary findings to FMD. Although there is limited evidence to guide treatment, many lesions heal spontaneously; thus, a conservative approach is generally preferred. The etiology is poorly understood, but there are ongoing efforts to better characterize FMD and define its genetic and molecular basis. This report reviews the clinical course of FMD involving the coronary arteries and provides guidance for diagnosis and treatment strategies.

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Post-mortem angiographic and histologic findings of coronary artery fibromuscular dysplasia

Cited by 11 publications

References 16 publications

Spontaneous Coronary Artery Dissection

Spontaneous Coronary Artery Dissection

Age-related fibromuscular dysplasia in the human left ventricle papillary muscles arteries

Coronary Artery Manifestations of Fibromuscular Dysplasia

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