Download Pathology of Rheumatic Diseases by Dr. med. Hans Georg Fassbender (auth.) PDF
By Dr. med. Hans Georg Fassbender (auth.)
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Sample text
In the heart valves, appearances differ from those in the general endocardial layer : fibrinoid is deposited focally rather than in a more diffuse arrangement. According to position and size of these foci, such surface deformity may result that warty fibrinous vegetations can be distinguished superficially. Subendothelial fibrinoid foci are far less common here than beads of fibrin which are commonly situated at the margins of cusps where they meet on closure. The topography of the subendothelial morbid process is inadequate to account for occurrence of these vegetations.
Small blood vessels may become involved where granulomata lie in close contact (Figs. 45 and 46). The difference in origin of the two types of reaction may indicate two different types of immunological mechanism : I. Fibrinoid is the result of pathologically increased capillary permeability whose cause in analogy with the Arthus reaction may be sought in the deposition of immune complexes. These consist of streptococcal antigens and antibodies which bind complement. Fibrin may be deposited in small amounts and be of short duration as in the granulomatous variety or, as in the so-called exudative type, there may be a rapid "flooding" of the myocardium by fibrin and granulocytes which may also represent a variety of Arthus phenomenon, as indicated by vascular necrosis (Fig.
As the scar tissue is formed around the constantly pulsating heart, a loose connective tissue network of spongy consistency results. differing by a considerable degree of plasticity from the usual collagenous scar tissue. In accordance with this, the newly formed vessels follow a tortuou s course. allowing for adaptation to cardiac movements. Thus. the heart is still enabled to pulsate with the necessary degree of freedom. Adhesions forming epicardiall y may be locally limited to individual fibre bundles or form a complete layer.