Histopathologic changes in ascending aorta and risk factors related to histopathologic conditions and aortic dilatation in patients with tetralogy of.

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Presentation transcript:

Histopathologic changes in ascending aorta and risk factors related to histopathologic conditions and aortic dilatation in patients with tetralogy of Fallot Ujjwal K. Chowdhury, MCh, Diplomate NB, Anand K. Mishra, MS, Ruma Ray, MD, MRC (Path), Mani Kalaivani, MSc (Biostatistics), Srikrishna M. Reddy, MS, Panangipalli Venugopal, MCh The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 1, Pages 69-77.e11 (January 2008) DOI: 10.1016/j.jtcvs.2007.06.011 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The receiver operating characteristic (ROC) curve of the patients in the study group to determine the predictive accuracy of the model after logistic regression was assessed using the area under the ROC curve. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 69-77.e11DOI: (10.1016/j.jtcvs.2007.06.011) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The receiver operating characteristic (ROC) curve of the study group to compare the trade-offs between the true-positive rate and the false-positive rate of low lamellar count. A lamellar count of 60 as the optimal cutoff point for an abnormal histopathologic condition in patients undergoing intracardiac repair with a sensitivity of 80% and specificity of 87.7%. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 69-77.e11DOI: (10.1016/j.jtcvs.2007.06.011) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 A and B, Photomicrographs of the ascending aortic biopsy specimen of a patient with tetralogy of Fallot (TOF) (light microscopy, elastic van Gieson stain ×40) showing normal aortic media with corrugated, closely packed, longitudinally arranged intact elastic lamellae in a mucopolysaccharide ground substance. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 69-77.e11DOI: (10.1016/j.jtcvs.2007.06.011) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 A and B, Photomicrographs of the ascending aorta of a patient with tetralogy of Fallot (TOF) (light microscopy ×100, Verhoeff van Gieson stain) showing widespread lamellar loss and elastic tissue fragmentation (B) as compared with intact lamellae of a patient with normal aorta (A). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 69-77.e11DOI: (10.1016/j.jtcvs.2007.06.011) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Photomicrographs of light microscopic biopsy from ascending aorta of patients with tetralogy of Fallot (TOF) (Verhoeff van Gieson stain ×100) showing closely packed, longitudinally arranged, intact elastic lamellae of a normal aorta (A and B) and varying grades of elastic fiber fragmentation of abnormal aorta (C to F). C and D, Widespread elastic fiber fragmentation and lamellar loss with large areas of ground substance accumulation and loss of smooth muscle. F, Large area of fibrosis replacing the elastic lamellae. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 69-77.e11DOI: (10.1016/j.jtcvs.2007.06.011) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 A to D, Photomicrographs of ascending aortic biopsy of patients with tetralogy of Fallot (TOF) (light microscopy, smooth muscle actin stain ×400 [A]; alcian blue periodic acid–Schiff stain ×100 [B to D]). A and B, Normal aorta with layers of longitudinally arranged, elastic lamellae interspersed with smooth muscle cells and collagen fibrils in a mucopolysaccharide ground substance. C and D, Disorganized media with loss of smooth muscle nuclei and varying grades of mucoid ground substance accumulation. D shows a large area of pools of mucopolysaccharides and collagen deposition. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 69-77.e11DOI: (10.1016/j.jtcvs.2007.06.011) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 A to D, Photomicrographs from ascending aortic biopsy specimens of patients with tetralogy of Fallot (TOF) (light microscopy, hematoxylin and eosin stain ×100) showing normal aortic media with layers of longitudinally arranged smooth muscle nuclei (A and B) and abnormal aorta with significant medial destruction and changes in smooth muscle orientation. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 69-77.e11DOI: (10.1016/j.jtcvs.2007.06.011) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E6 A to D, Photomicrographs from ascending aortic biopsy of patients with tetralogy of Fallot (TOF) (light microscopy, Masson trichrome stain ×100). A and B, Closely packed, longitudinally arranged, intact elastic lamellae. C and D, Mild increase in fibrosis with increased interstitial collagen. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 69-77.e11DOI: (10.1016/j.jtcvs.2007.06.011) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions