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Erschienen in: European Surgery 5/2014

01.11.2014 | Original Article

Giant cell and granulomatous myocarditis necessitating cardiac transplantation: clinical, gross, and histopathological findings

verfasst von: C. M. Steger, MD, D. Höfer, H. Antretter

Erschienen in: European Surgery | Ausgabe 5/2014

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Summary

Background

Giant cell myocarditis and granulomatous myocarditis are rare diseases, leading to severe heart symptoms like tachyarrhythmia or atrial fibrillation with frequently fatal outcome. Typically, diagnosis is confirmed at necropsy or in explanted hearts, as the majority of cases remain clinically unrecognized.

Methods

Explanted heart specimens of 355 heart transplant recipients receiving cardiac transplantation between January 1994 and December 2011 were examined. Unexpected granulomatous myocarditis was found in the explanted hearts of three patients and giant cell myocarditis in four patients. We investigated preoperative and postoperative course and gross and histopathological findings of these two different disorders, which were thought to be the same disease for a long time.

Results

Preoperatively, both groups suffered from mild to severe symptoms of heart failure. Gross findings of resected heart specimens showed right and left ventricular hypertrophy. Histological examination revealed a left ventricular endomyocardial fibrosis and inflammation infiltrates including giant cells with the presence or absence of granulomas. All patients with granulomatous myocarditis are alive. Three patients suffering from giant cell myocarditis showed a complicated postoperative clinical course, one heart transplant recipient developed Guillain–Barré syndrome due to cytomegalovirus reactivation 6 months after heart transplantation, another patient died due to cerebral edema shortly after transplantation, and another one died because of myocardial and cerebral infarction after tricuspid valve replacement.

Conclusions

In consideration of the limitation of this study that a small number of patients were included, our results suggest that patients suffering from granulomatous myocarditis are older at heart transplantation and have a more favorable outcome compared with heart transplant recipients with giant cell myocarditis.
Literatur
1.
Zurück zum Zitat Saltykow S. Über diffuse Myokarditis. Arch Pathol Lab Med Anat. 1905;182:1.CrossRef Saltykow S. Über diffuse Myokarditis. Arch Pathol Lab Med Anat. 1905;182:1.CrossRef
2.
Zurück zum Zitat Tesluk H. Giant cell versus granulomatous myocarditis. Am J Clin Pathol. 1956;26:1326–33.PubMed Tesluk H. Giant cell versus granulomatous myocarditis. Am J Clin Pathol. 1956;26:1326–33.PubMed
3.
Zurück zum Zitat Klein BR, Hedges TR, 3rd, Dayal Y, Adelman LS. Orbital myositis and giant cell myocarditis. Neurology. 1989;39:988–90.PubMedCrossRef Klein BR, Hedges TR, 3rd, Dayal Y, Adelman LS. Orbital myositis and giant cell myocarditis. Neurology. 1989;39:988–90.PubMedCrossRef
4.
Zurück zum Zitat de Jongste MJ, Oosterhuis HJ, Lie KI. Intractable ventricular tachycardia in a patient with giant cell myocarditis, thymoma and myasthenia gravis. Int J Cardiol. 1986;13:374–8.PubMedCrossRef de Jongste MJ, Oosterhuis HJ, Lie KI. Intractable ventricular tachycardia in a patient with giant cell myocarditis, thymoma and myasthenia gravis. Int J Cardiol. 1986;13:374–8.PubMedCrossRef
5.
Zurück zum Zitat Burke JS, Medline NM, Katz A. Giant cell myocarditis and myositis. Associated with thymoma and myasthenia gravis. Arch Pathol. 1969;88:359–66.PubMed Burke JS, Medline NM, Katz A. Giant cell myocarditis and myositis. Associated with thymoma and myasthenia gravis. Arch Pathol. 1969;88:359–66.PubMed
6.
Zurück zum Zitat Kloin JE. Pernicious anemia and giant cell myocarditis. New association. Am J Med. 1985;78:355–60.PubMedCrossRef Kloin JE. Pernicious anemia and giant cell myocarditis. New association. Am J Med. 1985;78:355–60.PubMedCrossRef
7.
Zurück zum Zitat McKeon J, Haagsma B, Bett JH, Boyle CM. Fatal giant cell myocarditis after colectomy for ulcerative colitis. Am Heart J. 1986;111:1208–9.PubMedCrossRef McKeon J, Haagsma B, Bett JH, Boyle CM. Fatal giant cell myocarditis after colectomy for ulcerative colitis. Am Heart J. 1986;111:1208–9.PubMedCrossRef
8.
Zurück zum Zitat Weidhase A, Grone HJ, Unterberg C, Schuff-Werner P, Wiegand V. Severe granulomatous giant cell myocarditis in Wegener’s granulomatosis. Klin Wochenschr. 1990;68:880–5.PubMedCrossRef Weidhase A, Grone HJ, Unterberg C, Schuff-Werner P, Wiegand V. Severe granulomatous giant cell myocarditis in Wegener’s granulomatosis. Klin Wochenschr. 1990;68:880–5.PubMedCrossRef
9.
Zurück zum Zitat Ariza A, López MD, Mate JL, Curós A, Villagrasa M, Navas-Palacios JJ. Giant cell myocarditis: monocytic immunophenotype of giant cells in a case associated with ulcerative colitis. Hum Pathol. 1995;26:121–3.PubMedCrossRef Ariza A, López MD, Mate JL, Curós A, Villagrasa M, Navas-Palacios JJ. Giant cell myocarditis: monocytic immunophenotype of giant cells in a case associated with ulcerative colitis. Hum Pathol. 1995;26:121–3.PubMedCrossRef
10.
Zurück zum Zitat Ruis J, Yebra M, Sánches-Vegazo I, Ramos MP, Lacoma F, Gea JC. Giant cell myocarditis: a systemic disease? Apropos a case. Med Clin (Barc). 1993;101:459–61. Ruis J, Yebra M, Sánches-Vegazo I, Ramos MP, Lacoma F, Gea JC. Giant cell myocarditis: a systemic disease? Apropos a case. Med Clin (Barc). 1993;101:459–61.
11.
Zurück zum Zitat Schmid KO. Granulomatous giant cell polymyositis and myocarditis in benign thymoma. Verh Dtsch Ges Pathol. 1965;49:248–53.PubMed Schmid KO. Granulomatous giant cell polymyositis and myocarditis in benign thymoma. Verh Dtsch Ges Pathol. 1965;49:248–53.PubMed
12.
13.
Zurück zum Zitat Truica CI, Hansen CH, Garvin DF, Meehan KR. Idiopathic giant cell myocarditis after autologous hematopoietic stem cell transplantation and interleukin-2 immunotherapy: a case report. Cancer. 1998;83:1231–6.PubMedCrossRef Truica CI, Hansen CH, Garvin DF, Meehan KR. Idiopathic giant cell myocarditis after autologous hematopoietic stem cell transplantation and interleukin-2 immunotherapy: a case report. Cancer. 1998;83:1231–6.PubMedCrossRef
14.
Zurück zum Zitat Cooper LT, Jr., Berry GJ, Shabetai R. Idiopathic giant cell myocarditis—natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators. N Engl J Med. 1997;336:1860–6.PubMedCrossRef Cooper LT, Jr., Berry GJ, Shabetai R. Idiopathic giant cell myocarditis—natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators. N Engl J Med. 1997;336:1860–6.PubMedCrossRef
15.
Zurück zum Zitat Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment. Circulation. 2006;113:876–90.PubMedCrossRef Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment. Circulation. 2006;113:876–90.PubMedCrossRef
16.
Zurück zum Zitat Kandolin R, Lehtonen J, Salmenkivi K, Räisänen-Sokolowski A, Lommi J, Kupari M. Diagnosis, treatment, and outcome of giant-cell moycarditis in the era of combined immunosuppression. Circ Heart Fail. 2013;6:15–22.PubMedCrossRef Kandolin R, Lehtonen J, Salmenkivi K, Räisänen-Sokolowski A, Lommi J, Kupari M. Diagnosis, treatment, and outcome of giant-cell moycarditis in the era of combined immunosuppression. Circ Heart Fail. 2013;6:15–22.PubMedCrossRef
17.
Zurück zum Zitat Kindermann I, Barth C, Mahfoud F, Ukena C, Lenski M, Yilmaz A, Klingel K, Kandolf R, Sechtem U, Cooper LT, Böhm M. Update on myocarditis. J Am Coll Cardiol. 2012;59:779–92.PubMedCrossRef Kindermann I, Barth C, Mahfoud F, Ukena C, Lenski M, Yilmaz A, Klingel K, Kandolf R, Sechtem U, Cooper LT, Böhm M. Update on myocarditis. J Am Coll Cardiol. 2012;59:779–92.PubMedCrossRef
18.
Zurück zum Zitat Cooper LT, Jr., ElAmm C. Giant cell myocarditis. Diagnosis and treatment. Herz. 2012;37:632–6.PubMedCrossRef Cooper LT, Jr., ElAmm C. Giant cell myocarditis. Diagnosis and treatment. Herz. 2012;37:632–6.PubMedCrossRef
19.
Zurück zum Zitat Cooper LT, Jr., Berry GJ, Rizeq M, Schroeder JS. Giant cell myocarditis. J Heart Lung Transplant. 1995;14:394–401.PubMed Cooper LT, Jr., Berry GJ, Rizeq M, Schroeder JS. Giant cell myocarditis. J Heart Lung Transplant. 1995;14:394–401.PubMed
20.
Zurück zum Zitat Moloney ED, Egan JJ, Kelly P, Wood AE, Cooper LT, Jr. Transplantation for myocarditis: a controversy revisited. J Heart Lung Transplant. 2005;24:1103–10.PubMedCrossRef Moloney ED, Egan JJ, Kelly P, Wood AE, Cooper LT, Jr. Transplantation for myocarditis: a controversy revisited. J Heart Lung Transplant. 2005;24:1103–10.PubMedCrossRef
21.
22.
Zurück zum Zitat Nieminen MS, Salminen US, Taskinen E, Heikkila P, Partanen J. Treatment of serious heart failure by transplantation in giant cell myocarditis diagnosed by endomyocardial biopsy. J Heart Lung Transplant. 1994;13:543–5.PubMed Nieminen MS, Salminen US, Taskinen E, Heikkila P, Partanen J. Treatment of serious heart failure by transplantation in giant cell myocarditis diagnosed by endomyocardial biopsy. J Heart Lung Transplant. 1994;13:543–5.PubMed
23.
Zurück zum Zitat Theaker JM, Gatter KC, Brown DC, Heryet A, Davies MJ. An investigation into the nature of giant cells in cardiac and skeletal muscle. Hum Pathol. 1988;19:974–9.PubMedCrossRef Theaker JM, Gatter KC, Brown DC, Heryet A, Davies MJ. An investigation into the nature of giant cells in cardiac and skeletal muscle. Hum Pathol. 1988;19:974–9.PubMedCrossRef
24.
Zurück zum Zitat Shariff S, Straatman L, Allard M, Ignaszewski A. Novel associations of giant cell myocarditis: two case reports and a review of the literature. Can J Cardiol. 2004;20:557–61.PubMed Shariff S, Straatman L, Allard M, Ignaszewski A. Novel associations of giant cell myocarditis: two case reports and a review of the literature. Can J Cardiol. 2004;20:557–61.PubMed
25.
Zurück zum Zitat Schumann C, Faust M, Gerharz M, Ortmann M, Schubert M, Krone W. Autoimmune polyglandular syndrome associated with idiopathic giant cell myocarditis. Exp Clin Endocrinol Diabetes. 2005;113:302–7.PubMedCrossRef Schumann C, Faust M, Gerharz M, Ortmann M, Schubert M, Krone W. Autoimmune polyglandular syndrome associated with idiopathic giant cell myocarditis. Exp Clin Endocrinol Diabetes. 2005;113:302–7.PubMedCrossRef
26.
Zurück zum Zitat Frustaci A, Cuoco L, Chimenti C, et al. Celiac disease associated with autoimmune myocarditis. Circulation. 2002;105:2611–8.PubMedCrossRef Frustaci A, Cuoco L, Chimenti C, et al. Celiac disease associated with autoimmune myocarditis. Circulation. 2002;105:2611–8.PubMedCrossRef
27.
Zurück zum Zitat Nash CL, Panaccione R, Sutherland LR, Meddings JB. Giant cell myocarditis, in a patient with Crohn’s disease, treated with etanercept—a tumour necrosis factor-alpha antagonist. Can J Gastroenterol. 2001;15:607–11.PubMed Nash CL, Panaccione R, Sutherland LR, Meddings JB. Giant cell myocarditis, in a patient with Crohn’s disease, treated with etanercept—a tumour necrosis factor-alpha antagonist. Can J Gastroenterol. 2001;15:607–11.PubMed
28.
Zurück zum Zitat Kilgallen CM, Jackson E, Bankoff M, Salomon RN, Surks HK. A case of giant cell myocarditis and malignant thymoma: a postmortem diagnosis by needle biopsy. Clin Cardiol. 1998;21:48–51.PubMedCrossRef Kilgallen CM, Jackson E, Bankoff M, Salomon RN, Surks HK. A case of giant cell myocarditis and malignant thymoma: a postmortem diagnosis by needle biopsy. Clin Cardiol. 1998;21:48–51.PubMedCrossRef
29.
Zurück zum Zitat Kon T, Mori F, Tanji K, Miki Y, Kimura T, Wakabayashi K. Giant cell polymyositis and myocarditis associated with myasthenia gravis and thymoma. Neuropathology. 2013;33:281–7.PubMedCrossRef Kon T, Mori F, Tanji K, Miki Y, Kimura T, Wakabayashi K. Giant cell polymyositis and myocarditis associated with myasthenia gravis and thymoma. Neuropathology. 2013;33:281–7.PubMedCrossRef
30.
Zurück zum Zitat Tanahashi N, Sato H, Nogawa S, Satoh T, Kawamura M, Shimoda M. A case report of giant cell moycardits and myositis observed during the clinical course of invasive thymoma associated with myasthenia gravis. Keio J Med. 2004;53:30–42.PubMed Tanahashi N, Sato H, Nogawa S, Satoh T, Kawamura M, Shimoda M. A case report of giant cell moycardits and myositis observed during the clinical course of invasive thymoma associated with myasthenia gravis. Keio J Med. 2004;53:30–42.PubMed
31.
Zurück zum Zitat Sato H, Iwasaki E, Nogawa S, Suzuki S, Amano T, Fukuuchi Y, et al. A patient with giant cell myocarditis and myositis associated with thymoma and myasthenia gravis. Rinsho Shinkeigaku. 2003;43:496–9.PubMed Sato H, Iwasaki E, Nogawa S, Suzuki S, Amano T, Fukuuchi Y, et al. A patient with giant cell myocarditis and myositis associated with thymoma and myasthenia gravis. Rinsho Shinkeigaku. 2003;43:496–9.PubMed
32.
Zurück zum Zitat Ibi T, Sahashi K. Myasthenia gravis, giant cell polymyositis and cardiomyositis associated with thymoma. Ryoikibetsu Shokogun Shirizu. 2001;36:344–6. Ibi T, Sahashi K. Myasthenia gravis, giant cell polymyositis and cardiomyositis associated with thymoma. Ryoikibetsu Shokogun Shirizu. 2001;36:344–6.
33.
Zurück zum Zitat Tomimoto H, Akiguchi I, Kameyama M, Haibara H, Kitaichi M. Giant cell myositis and myocarditis associated with myasthenia gravis and thymoma—an autopsy case. Rinsho Shinkeigaku. 1985;25:688–93.PubMed Tomimoto H, Akiguchi I, Kameyama M, Haibara H, Kitaichi M. Giant cell myositis and myocarditis associated with myasthenia gravis and thymoma—an autopsy case. Rinsho Shinkeigaku. 1985;25:688–93.PubMed
34.
Zurück zum Zitat Bourgeois-Droin C, Sauvanet A, Lemarchand F, De Roquancourt A, Cottenot F, Brocheriou C. Thymoma associated with myasthenia, erythroblastopenia, myositis and giant cell myocarditis. One case (author’s transl). Nouv Presse Med. 1981;10:2097–8.PubMed Bourgeois-Droin C, Sauvanet A, Lemarchand F, De Roquancourt A, Cottenot F, Brocheriou C. Thymoma associated with myasthenia, erythroblastopenia, myositis and giant cell myocarditis. One case (author’s transl). Nouv Presse Med. 1981;10:2097–8.PubMed
35.
Zurück zum Zitat Leib ML, Odel JG, Cooney MJ. Orbital polymyositis and giant cell myocarditis. Ophthalmology. 1994;101:950–4.PubMedCrossRef Leib ML, Odel JG, Cooney MJ. Orbital polymyositis and giant cell myocarditis. Ophthalmology. 1994;101:950–4.PubMedCrossRef
36.
Zurück zum Zitat Lind-Ayres MR, Abramowsky C, Mahle WT. Pediatric giant cell myocarditis and orbital myositis. Pediatr Cardiol. 2009;30:510–2.PubMedCrossRef Lind-Ayres MR, Abramowsky C, Mahle WT. Pediatric giant cell myocarditis and orbital myositis. Pediatr Cardiol. 2009;30:510–2.PubMedCrossRef
37.
Zurück zum Zitat Kollmeier M, Brodhun M, Sliwka U, Sigusch H, Witte OW, Heide G. Diplopia and cardiogenic shock. Nervenarzt. 2006;77:187–8.PubMedCrossRef Kollmeier M, Brodhun M, Sliwka U, Sigusch H, Witte OW, Heide G. Diplopia and cardiogenic shock. Nervenarzt. 2006;77:187–8.PubMedCrossRef
38.
Zurück zum Zitat Sasaki H, Yano M, Kawano O, Hikosaka Y, Fujii Y. Thymoma associated with fatal myocarditis and polymyosisit in a 58-year-old man following treatment with carboplatin and paclitaxel: a case report. Oncol Lett. 2012;3:300–2.PubMedCentralPubMed Sasaki H, Yano M, Kawano O, Hikosaka Y, Fujii Y. Thymoma associated with fatal myocarditis and polymyosisit in a 58-year-old man following treatment with carboplatin and paclitaxel: a case report. Oncol Lett. 2012;3:300–2.PubMedCentralPubMed
39.
Zurück zum Zitat Morrissey RP, Rana JS, Luthringer DJ, Cheng V, Czer LS, Philip K, Kass R, Schwarz ER. Case of fulminant giant-cell myocarditis associated with polymyositis, treated with a biventricular assist device and subsequent heart transplantation. Heart Lung. 2011;40:340–5.PubMedCrossRef Morrissey RP, Rana JS, Luthringer DJ, Cheng V, Czer LS, Philip K, Kass R, Schwarz ER. Case of fulminant giant-cell myocarditis associated with polymyositis, treated with a biventricular assist device and subsequent heart transplantation. Heart Lung. 2011;40:340–5.PubMedCrossRef
40.
Zurück zum Zitat Isobe K, Gocho K, Kaburaki K, Sugino K, Akasaka Y, Homma S. An autopsied case of giant cell myocarditis and myositis associated with invasive thymoma. Nihon Kokyuki Gakkai Zasshi. 2010;48:432–8.PubMed Isobe K, Gocho K, Kaburaki K, Sugino K, Akasaka Y, Homma S. An autopsied case of giant cell myocarditis and myositis associated with invasive thymoma. Nihon Kokyuki Gakkai Zasshi. 2010;48:432–8.PubMed
41.
Zurück zum Zitat Roberts WC, Kehoe JA, Carpenter DF, Golden A. Cardiac valvular lesions in rheumatoid arthritis. Arch Intern Med. 1968;122:141–6.PubMedCrossRef Roberts WC, Kehoe JA, Carpenter DF, Golden A. Cardiac valvular lesions in rheumatoid arthritis. Arch Intern Med. 1968;122:141–6.PubMedCrossRef
42.
43.
Zurück zum Zitat Benisch BM, Josephson M. Subacute (giant cell) thyreoiditis and giant cell myocarditis in patient with carcinoma of lung. Chest. 1973;64:764–5.PubMedCrossRef Benisch BM, Josephson M. Subacute (giant cell) thyreoiditis and giant cell myocarditis in patient with carcinoma of lung. Chest. 1973;64:764–5.PubMedCrossRef
44.
Zurück zum Zitat McCrea PC, Childers RW. Two unusual cases of giant cell myocarditis associated with mitral stenosis and with Wegener’s syndrome. Br Heart J. 1964;26:490–8.PubMedCentralPubMedCrossRef McCrea PC, Childers RW. Two unusual cases of giant cell myocarditis associated with mitral stenosis and with Wegener’s syndrome. Br Heart J. 1964;26:490–8.PubMedCentralPubMedCrossRef
45.
48.
Zurück zum Zitat Koul D, Kanwar M, Jefic D, et al. Fulminant giant cell myocarditis and cardiogenic shock: an unusual presentation of malignant thymoma. Cardiol Res Pract. 2010;2010:185896.PubMedCentralPubMed Koul D, Kanwar M, Jefic D, et al. Fulminant giant cell myocarditis and cardiogenic shock: an unusual presentation of malignant thymoma. Cardiol Res Pract. 2010;2010:185896.PubMedCentralPubMed
49.
Zurück zum Zitat Ishikawa H, Kaneko H, Watanabe H, Takagi A, Ming ZW. Giant cell myocarditis in association with drug-induced skin eruption. Acta Pathol Jpn. 1987;37:639–44.PubMed Ishikawa H, Kaneko H, Watanabe H, Takagi A, Ming ZW. Giant cell myocarditis in association with drug-induced skin eruption. Acta Pathol Jpn. 1987;37:639–44.PubMed
50.
Zurück zum Zitat Daniels PR, Berry GJ, Tazelaar HD, Cooper LT. Giant cell myocarditis as a manifestation of drug hypersensitivity. Cardiovasc Pathol. 2000;9:287–91.PubMedCrossRef Daniels PR, Berry GJ, Tazelaar HD, Cooper LT. Giant cell myocarditis as a manifestation of drug hypersensitivity. Cardiovasc Pathol. 2000;9:287–91.PubMedCrossRef
51.
Zurück zum Zitat Kossovsky N, Cole P, Zackson DA. Giant cell myocarditis associated with silicone. An unusual case of biomaterials pathology discovered at autopsy using x-ray energy spectroscopic techniques. Am J Clin Pathol. 1990;93:148–52.PubMed Kossovsky N, Cole P, Zackson DA. Giant cell myocarditis associated with silicone. An unusual case of biomaterials pathology discovered at autopsy using x-ray energy spectroscopic techniques. Am J Clin Pathol. 1990;93:148–52.PubMed
52.
Zurück zum Zitat Laufs H, Nigrovic PA, Schneider LC, et al. Giant cell myocarditis in a 12-year-old girl with common variable immunodeficiency. Mayo Clin Proc. 2002;77:92–6.PubMedCrossRef Laufs H, Nigrovic PA, Schneider LC, et al. Giant cell myocarditis in a 12-year-old girl with common variable immunodeficiency. Mayo Clin Proc. 2002;77:92–6.PubMedCrossRef
54.
Zurück zum Zitat Rabson AB, Schoen FJ, Warhol MJ, Mudge GH, Collins JJ, Jr. Giant cell myocarditis after mitral valve replacement: case report and studies of the nature of giant cells. Hum Pathol. 1984;15:585–7.PubMedCrossRef Rabson AB, Schoen FJ, Warhol MJ, Mudge GH, Collins JJ, Jr. Giant cell myocarditis after mitral valve replacement: case report and studies of the nature of giant cells. Hum Pathol. 1984;15:585–7.PubMedCrossRef
55.
Zurück zum Zitat Steger CM, Hager T, Antretter H, et al. Cardiac sarcoidosis mimicking arrhythmogenic right ventricular dysplasia. BMJ Case Rep. 2009;2009. pii: bcr08.2009.2204. doi:10.1136/bcr.08.2009.2204. Steger CM, Hager T, Antretter H, et al. Cardiac sarcoidosis mimicking arrhythmogenic right ventricular dysplasia. BMJ Case Rep. 2009;2009. pii: bcr08.2009.2204. doi:10.1136/bcr.08.2009.2204.
56.
Zurück zum Zitat Steger CM, Antretter H, Höfer D. Guillain-Barré syndrome due to CMV reactivation after cardiac transplantation. Case Rep Cardiol. 2012;2012:Article ID 506290. Steger CM, Antretter H, Höfer D. Guillain-Barré syndrome due to CMV reactivation after cardiac transplantation. Case Rep Cardiol. 2012;2012:Article ID 506290.
57.
Zurück zum Zitat Steger CM, Antretter H, Höfer D. Cardiac involvement in muscular dystrophies leading to heart transplantation. Eur Surg. 2013;45:245–50.CrossRef Steger CM, Antretter H, Höfer D. Cardiac involvement in muscular dystrophies leading to heart transplantation. Eur Surg. 2013;45:245–50.CrossRef
Metadaten
Titel
Giant cell and granulomatous myocarditis necessitating cardiac transplantation: clinical, gross, and histopathological findings
verfasst von
C. M. Steger, MD
D. Höfer
H. Antretter
Publikationsdatum
01.11.2014
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 5/2014
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-014-0269-5

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