ABC | Volume 111, Nº2, August 2018

Anatomopathological Session Favarato & Aiello A 59-year-old woman with rheumatic mitral valve disease with severe dyspnea, shock and pulmonary condensation. Arq Bras Cardiol. 2018; 111(2):215-222 Figure 7 – Base of the heart from where the atria were removed. Observe that the aortic valve (Ao) is preserved and the tricuspid valve (Tr) shows insufficiency secondary to the ring dilatation. Figure 8 – Surface of a lung cut with thrombus-plunger in hilar artery (arrow) and purplish-red areas at the base. Cause of death : Pulmonary thromboembolism (Prof. Dr. Vera Demarchi Aiello) Comments The involvement of the mitral valve in this case is typical of rheumatic disease sequelae, and the heart showed signs of de-compensation, such as marked dilation of the atria. Signals of terminal shock were found in the various organs. The involvement of only the mitral valve is common in rheumatic disease, and it can be found in over 50% of the cases of chronic rheumatic diseases as double dysfunction (stenosis and insufficiency) or just insufficiency. 21 No lesions were found in arterial or venous thoracic vessels able to explain hemothorax. The pulmonary situation included recent aspects, such as thromboembolism of hilar vessels and pulmonary infarcts, with other chronic ones, characterized by long-term chronic passive congestion. Passive congestion ends up by causing passive pulmonary hypertension, which starts in the venous territory. The case under discussion presented lesions in venules characteristic of this type of impairment. In the last classification of pulmonary hypertension, this group (of hypertension secondary to lesions of the left heart) is known as pulmonary hypertension group 2. 22 In addition to the lesions in the cardiac valves on the left side, myocardial diseases can also evolve chronically with secondary pulmonary hypertensive involvement. Individuals thus affected can have a troubled evolution in the postoperative period of valve surgery, or that of a cardiac transplantation, when this is a therapeutic option. A recent study by our laboratory revealed that venous lesions of pulmonary hypertension group 2 are frequent and that the appearance of phosphodiesterase 5 in pulmonary vessels of those patients is greater than in the normal ones. 23 (Prof. Dr. Vera Demarchi Aiello) 220