Pathology of Interventional Therapies

Question 1

What is percutaneous coronary intervention and what is it used to treat?

Answer 1

Procedure used to mechanically dilate artery narrowed by athersclerosis and keep lumen open;

Question 2

What is coronary bypass grafting and what is it used to treat?

Answer 2

A procedure in which saphenous veins or left internal mammary artery is used to to direct blood around a blockage (common Tx for proximal coronary stenosis)

Question 3

What are 3 of the common causes that perfusion is not improved?

Answer 3

1. Early thrombosis
2. Intimal Hyperplasia
3. Atherosclerosis of Vein Grafts

Question 4

What is the most common cause of vein graft failure?

Answer 4

Atherosclerosis

Question 5

What are the two types of valve replacements and what are the complications of each?

Answer 5

1. Tissue valve - tissue degeneration with severe calcification and fragmentation of the prosthetic valve cusps
2. Mechanical valve - risk of thromboembolism

Question 6

What are the 4 types of transplant rejection?

Answer 6

1. Hyperacute rejection
2. Acute humoral rejection
3. Acute cellular rejection
4. Chronic vascular rejection (accelerated coronary artery disease)

Question 7

What is hyperacute rejection and what causes it?

Answer 7

Blood group incompatibility or MHC incompatibility resulting in diffuse hemorrhage, edema, necrosis and neutrophil infiltration

Question 8

What is acute humoral rejection?

Answer 8

Vascular deposition of antibody and complement, endothelial cell swelling and edema; It is an uncommon form of rejection

Question 9

What is acute cellular rejection? What is the pharmacologic course of action?

Answer 9

Begins as perivascular T-cell infiltration which is focal and not associated with necrosis. Moderate cellular rejection is characterizef by T-cell infiltration into adjacent interstitial spaces; Further immunosuppresion because moderate rejection can lead to severe rejection

Question 10

What is the most common cause of death in heart transplant patients?

Answer 10

Chronic vascular rejection

Question 11

Why is chronic vascular rejection silent?

Answer 11

The heart is denervated and the patient is unaware that there is concentric intimal proliferation and ischemia

Question 12

A patient with a heart transplant unexpectedly dies and one of his coronary arteries are shown below. What is the Dx?

Answer 12

Chronic vascular rejection (Accelerated coronary artery disease)