ABC | Volume 114, Nº4, Suplement, April 2020

Anatomopathological Correlation Favarato & Benvenuti Heart failure after myocardial infarction an rupture of chordae tendineae Arq Bras Cardiol 2020; 114(4Suppl.1):47-56 areas of necrosis and the presence of microstructures compatible with degenerated bacteria (Figure 7). The heart weighed 396 g, with dilation in both atria, particularly the left one. Presence of a pericardium patch measuring 15 mm in diameter, adequately occluding the atrial septal defect in the oval fossa (Figure 8). The mitral valve showed posterior cusp repair, with the presence of recent extensive surgical sutures with a reinforcement area; however, there was a clear retraction of part of the cusp, with a consequent absence of adequate coaptation (Figure 8). The anterior cusp showed slight thickening and bulging, with thin and delicate chordae tendineae. There were no vegetations. The other cardiac valves showed no abnormalities. There was evidence of recent CABG surgery, with anastomosis of the mammary artery to the anterior interventricular artery and a saphenous vein graft to the distal segment of the right coronary artery, both patent. Cross- sections of the ventricles showed mild left myocardiosclerosis, with no areas of acute infarction. The pulmonary artery was dilated, with the presence of discrete atherosclerotic plaques in the main branches. The aorta and coronary arteries showed mild / moderate atherosclerosis, with focally calcified and ulcerated plaques in the first. Lung examination showed chronic passive congestion and extensive infarction areas at the base of the right lower lobe, with smaller ones in posterior regions of the upper and lower left lobes. The histological examination confirmed the diagnosis of pulmonary infarction, with areas of septic aspect showing intense purulent neutrophilic infiltrate, with the presence of microstructures compatible with degenerated bacteria (Figure 9). Examination of the digestive tract showed multifocal brownish granular areas covering the mucosa of the large intestine, with histological examination compatible with acute pseudomembranous colitis (Figure 10). Other necropsy findings were diffuse liver steatosis, vascular kidney with renal scarring and areas of parenchymal atrophy, and mild lymphocytic pancreatitis with parenchymal cells showing viral inclusion with a cytomegalic pattern (Figure 11). The examination of the brain showed no abnormalities. (Dr. Luiz Alberto Benvenuti) Anatomopathological diagnoses Operated degenerative mitral valve prolapse, with residual mitral regurgitation; atherosclerosis of the aorta and coronary arteries, with CABG surgery; soft tissue bacterial infection in the saphenectomy region; acute pseudomembranous colitis; pancreatitis due to cytomegalovirus; hepatic steatosis; septicemia with multiple pulmonary infarctions (cause of death). (Dr. Luiz Alberto Benvenuti) Comments The present case refers to a 56-year-old woman submitted to mitral valve surgery and CABG surgery approximately 2 ½ months before death. The patient had congestive heart failure, mitral valve prolapse with severe regurgitation 11 and coronary obstruction detected by coronary angiography, with the largest lesion located in the posterior descending artery (90% obstruction). She underwent surgical correction of valvar heart disease (repair with quadrangular resection of the posterior cusp), on which occasion the presence of a large Figure 7 - Histological section of the subcutaneous tissue in the saphenectomy suture region showing an intense purulent inflammatory process with areas of tissue necrosis. Hematoxylin-eosin staining. 53