Η πρωτεΐνη YKL-40 είναι μια εκκρινόμενη πρωτεΐνη, μέλος της οικογένειας των γλυκοπρωτεϊνών που ομοιάζουν με χιτινάση. Περιέχει καλά συντηρημένες περιοχές που προσδένουν χιτίνη, στερείται όμως της ενζυματικής δράσης της χιτινάσης εξαιτίας μιας σημειακής μετάλλαξης στην καταλυτική περιοχή. Από την υπάρχουσα βιβλιογραφία φαίνεται να εμπλέκεται στη διαδικασία της φλεγμονής αλλά και στη δημιουργία ίνωσης και νεοαγγειογένεσης. Στην παρούσα μελέτη, θελήσαμε να διερευνήσουμε την έκφραση της YKL-40 με την τεχνική της ανοσοιστοχημείας σε μιτροειδείς βαλβίδες του ανθρώπου με ιστοπαθολογικές αλλοιώσεις ( βλεννώδη εκφύλιση ,ινωση ,νεοαγγειογένεση ασβέστωση ) και να συσχετίσουμε την πιθανή έκφραση της πρωτεϊνης με την παρουσία και την σοβαρότητα αυτών των αλλοιώσεων καθώς και με άλλες κλινικοπαθολογοανατομικές παραμέτρους της νόσου Χρησιμοποιήθηκαν συνολικά δείγματα από 71 περιστατικά μιτροειδών βαλβίδων μονιμοποιημένα σε ουδέτερη φορμόλη 10% και εγκλεισμένα σε παραφίνη. Εκ των οποίων τα 52 ήταν παθολογικά και τα 19 ήταν φυσιολογικά. Εφαρμόσθηκε η τεχνική της ανοσοιστοχημείας και τα αντισώματα YKL-40, VEGFA, CD31, CD68 και A-SMA. Η στατιστική ανάλυση των αποτελεσμάτων έγινε με τη χρήση του στατιστικού πακέτου SPSS 10.0 for Windows. Τα αποτελέσματα της μελέτης έδειξαν ότι η πρωτεΐνη YKL-40 υπερεκφράζεται στις παθολογικές βαλβίδες (στα μακροφάγα, στα ενδοθηλιακά και στα διάμεσα βαλβιδικά κύτταρ ) και ότι τα υψηλά επίπεδα έκφρασης της σχετίζονται με τη σοβαρότητα των ιστοπαθολογικών αλλοιώσεων. Μόνο σε 2 από τις 19 φυσιολογικές βαλβίδες παρατηρήθηκε θετική ανοσοϊστοχημική χρώση, στις υπόλοιπες 17 ήταν αρνητική. Η ανοσοϊστοχημική χρώση της πρωτεΐνης YKL-40 στις μιτροειδείς βαλβίδες είχε στατιστικά σημαντική σχέση με την ανοσοϊστοχημική έκφραση της πρωτεΐνης A-SMA, της πρωτεΐνης VEGFA, με την παρουσία μακροφάγων και την μέση αγγειακή πυκνότητα.Τα επίπεδα έκφρασης της πρωτεΐνης YKL-40 ήταν μεγαλύτερα στις γυναίκες με νόσο μιτροειδούς βαλβίδας και σχετίζονται στατιστικά σημαντικά με την ηλικία. Με βάση τα ανωτέρω αποτελέσματα, μπορούμε να εισηγηθούμε ένα πιθανό ρόλο της πρωτεΐνης YKL-40 στην παθογένεια της νόσου της μιτροειδούς βαλβίδας , καθώς φάνηκε να εκφράζεται από διάφορους κυτταρικούς τύπους στις παθολογικές βαλβίδες σε σχέση με τις φυσιολογικές όπου δεν παρατηρήθηκε ανοσοθετικότητα του μορίου. Η έκφραση της πρωτεΐνης YKL-40 είχε θετική συσχέτιση με την έκφραση της a-SMA στα διάμεσα κύτταρα της βαλβίδας γεγονός που πιθανολογεί το ενδεχόμενο η πρωτεϊνη YKL-40 να προκαλεί ενεργοποίηση των διάμεσων βαλβιδικών κυττάρων με αποτέλεσμα την παραγωγή πρωτεϊνών εξωκυτταρίου ουσίας με τελική κατάληξη τη δημιουργία βλεννώδους εκφύλισης και ίνωσης . Επιπροσθέτως θα μπορούσαμε να υποθέσουμε λογω της θετικής συσχέτισης της έκφρασης της πρωτεΐνης YKL-40 με την έκφραση του VEGFA από τα βαλβιδικα κύτταρα και τα μακροφαγα ότι η πρωτεΐνη YKL-40 πιθανόν να επάγει την έκφραση του VEGFA από τα κύτταρα αυτά. Επιπρόσθετα, όπως η υπάρχουσα βιβλιογραφία υποστηρίζει, τόσο ξεχωριστά όσο και συνεργικά ο VEGFA και η YKL-40 είναι δυνατον να προκαλούν ενεργοποίηση, χημειοταξία και μετανάστευση ενδοθηλιακών κυττάρων εντός της γλωχίνας και σχηματισμό νέων αγγείων. Τα νέα αυτά αγγεία θα μπορούσαν να λειτουργήσουν θετικά ως προς την φλεγμονώδη διαδικασία προσκομίζοντας στις ήδη παχυσμένες βαλβίδες θρεπτικά συστατικά καθώς και μόρια και κύτταρα του ανοσοποιητικού συστήματος. Η παρουσία των μακροφάγων στις παθολογικές βαλβίδες φαίνεται να παίζει κεντρικό ρόλο στην ανάπτυξη των φλεγμονωδών αλλοιώσεων. Η στατιστικά σημαντική σχέση των μακροφάγων με την πρωτεΐνη YKL-40, σε συνδυασμό με την υπάρχουσα βιβλιογραφία που υποστηρίζει τόσο την έκκριση της πρωτεΐνης από τα μακροφάγα, όσο και την επίδραση της σε αυτά, μας επιτρέπει να υποθέσουμε και ένα παρόμοιο μηχανισμό στη νόσο της μιτροειδούς βαλβίδας. Αν και τα αποτελεσματα της παρουσας μελέτης είναι ενδεικτικά πιθανης συμμετοχής της YKL-40 στην νόσο της μιτροειδούς βαλβίδας χρειάζονται πολύ περισσοτερες μελέτες για να αποσαφηνισθεί ο ακριβής ρόλος της πρωτεΐνης YKL-40 στη παθογενεια της συγκεκριμένης νόσου / The protein YKL-40 is a secreted protein, a member of the family of chitinase-like glycoprotein. The protein YKL-40 contains well conserved regions that bind chitin, but lacks the enzymatic chitinase activity, because of a point mutation in the catalytic region. From the existing scientific literature it seems to be involved in the immigration and macrophage activation process in the site of inflammation. It is also possible to participate in the process of neoangiogenesis and fibrosis. Scientists argue that the protein YKL-40 participates in many diseases which are characterized by development of inflammation and has been proposed to use the protein YKL-40 as an indicator of prognosis, recurrence and treatment response in serum of patients with inflammatory diseases and malignancies. In this study, as the disease of the mitral valve is characterized by development of inflammation and because of existing studies that suggest that the protein YKL-40 induces the expression of VEGF-A protein and also has angiogenetic activity itself, we wanted to investigate the possible positive immunohistochemical staining of protein YKL-40 comparing physiological and pathological histological sections of mitral valve. A total sample of 71 cases was used. The 19 of them were normal and the 52 had lesions. The material was fixed tissue samples in 10% neutral formalin and embedded in paraffin. The 36 came from autopsy material and the remaining 35 of mitral valve replacement surgery. The kind of methodology that was followed was the indirect immunohistochemical method of streptavidin-DAB. The antibodies used were against the protein YKL-40, VEGF-A, CD31 (vascular endothelium), CD68 (macrophages) and A-SMA (activated valve interstitial cells). The statistical analysis was performed using the statistical package SPSS 10.0 for Windows. The study gave the following results: The protein YKL-40 is overexpressed in the pathological valves and its levels was related to the severity of the lesions. Cytoplasmic immunopositivity was present in macrophages, endothelial cells of the outer layers of the valves and the valves’ vessels and valve interstitial cells. Only 2 of the 19 normal valves had positive immunohistochemical stain of the protein YKL-40. Sufficient number of CD68 -positive macrophage was observed in the valves which presented histopathological lesions. The number of macrophages was significantly correlated with the severity of lesions. It was demonstrated the presence of vessels in pathological valves by immunohistochemical staining against the protein CD31. The average microvessel density was correlated with the severity of histological lesions. Pathological valves observed strong immunohistochemical expression of the protein A-SMA in the cells of the matrix. The expression of protein A-SMA was correlated significantly with the severity of lesions. The VEGF-A protein was overexpressed in pathological valves and was related to the severity of histopathological lesions. The cells which had positive immunostaining for the VEGF-A protein were macrophages, endothelial cells of valve blood vessels and valve interstitial cells. Immunohistochemical staining of the protein YKL-40 in the mitral valve was statistically significant compared to the immunohistochemical expression of the protein A-SMA, the protein VEGF-A, with the presence of macrophages and average microvessel density. The expression levels of the protein YKL-40 was higher in women with mitral valve disease and significantly associated with age. According to the previous comments, we propose the possible role of the protein YKL-40 in the pathogenesis of mitral valve disease. The protein YKL-40 seems to be expressed from multiple cellular types in pathological valves. As a different, the normal valves had non immunopositivity of the molecule. The YKL-40 protein was immunohistochemical localization in cells with morphological characteristics similar to those that were stained positive for a-SMA. Therefore, there is possibility that the presence of the protein YKL-40 in the valve interstitial cells is associated with increased cellularity of diseased valves, via the possible increase of the proliferation and activation of valve interstitial cells. As a result, the produce of ECM proteins causes mucous degeneration and fibrosis. Additionally we will assume that the protein YKL-40 is likely to induce the expression of VEGF-A from valve interstitial cells and/or macrophages during the pathogenesis of mitral valve disease. As the present bibliography consider, both separately and synergistically the protein YKL-40 is able to cause activation, chemo taxis and migration of endothelial cells within the cusp and neovascularization. These new vessels could operate positively to the inflammatory process by providing the thickened valves nutrients and molecules and cells of the immune system. The presence of macrophages at the valve lesions seems to play a major role at the inflammation procedure. Both of the statistically significant colleration between macrophages and protein YKL_40 and the current bibliography that suggests the expression of the protein YKL-40 from macrophages and the effect of the protein on them, make us to hypothesize that there is a similar mechanism at the mitral valve disease to. More research is required in order to make clear the exact role of protein YKL-40 in the mitral valve disease.

INTRODUÇÃO: O conhecimento anatômico desempenha importante papel no desenvolvimento de técnicas diagnósticas e cirúrgicas. Com esse objetivo, na área cardiológica, se mostra fundamental para o entendimento do processo de remodelamento cardíaco que acompanha as cardiomiopatias dilatadas (CMD) tanto isquêmicas (CMDIsq) como idiopáticas (CMDId), de modo particular do ventrículo esquerdo (VE) e sua correlação com alterações do anel atrioventricular esquerdo, levando a graus variáveis de insuficiência cardíaca (IC). OBJETIVOS: Os objetivos desta pesquisa são: 1) Obter medidas do anel atrioventricular esquerdo (mitral) e do ventrículo esquerdo em corações normais, com CMDIsq ou CMDId, comparando-as entre si; 2) Analisar a proporcionalidade entre segmentos da câmara ventricular esquerda dos corações com CMDIsq ou CMDId em relação ao normal; 3) Determinar a esfericidade ou não da câmara ventricular esquerda nos corações com CMDIsq ou CMDId. MÉTODO: Foram analisados 43 corações humanos, divididos em três grupos: NORMAL (n=10), CMDIsq (n=15) e CMDId (n=18). De posse da medida da distância do sulco atrioventricular posterior até o ápice do VE, foram realizados cortes transversais baso-apicais seqüenciais e, após digitalização dos mesmos, por meio de método computadorizado, foram obtidas medidas perimetrais e espessura das paredes. Empregando-se o mesmo método, mensurou-se o perímetro do anel mitral. Foram criados índices de proporção porcentual entre os perímetros dos segmentos provenientes dos cortes do VE, comparando-os intergrupos. Nos dilatados os perímetros segmentares mensurados foram comparados com os perímetros esperados se considerássemos a câmara ventricular como uma esfera perfeita. Realizou-se a análise estatística dessas medidas e índices. RESULTADOS: O perímetro do anel mitral teve o seguinte resultado: somente o grupo CMDIsq teve média significativamente maior que o grupo NORMAL e houve baixo coeficiente de correlação com os perímetros ventriculares segmentares nos corações dilatados. Distância do sulco atrioventricular até o ápice do VE: CMDId = CMDIsq > NORMAL. Perímetros segmentares ventriculares basais (PerB), equatoriais (PerE) e apicais (PerA): grupo NORMAL-> PerE = PerB > PerA; grupos CMDId e CMDIsq- > PerE > PerB > PerA, sendo que o grupo CMDId teve essas 3 medidas maiores que o grupo CMDIsq e ambos tiveram essas 3 medidas maiores que o grupo NORMAL. Nos 3 grupos as medidas de espessura das paredes ventriculares foram iguais estatisticamente. O índice de proporção perimetral PerB/PerE foi igual nos 3 grupos, enquanto o índice PerA/PerE foi igual entre os corações dilatados, mas em ambos foi menor que no grupo NORMAL. Todos perímetros segmentares ventriculares dos corações dilatados foram menores do que os calculados segundo a fórmula da esfera. CONCLUSÕES: 1) O anel atrioventricular esquerdo dilata-se na CMDIsq, sendo essa alteração independente da dilatação dos três segmentos do VE; 2) Os corações com CMDId e CMDIsq desenvolvem uma similar dilatação longitudinal do VE; 3) Ocorre uma dilatação trans versal do VE nessas afecções, sendo essa maior nos corações com CMDId; 4) A espessura das paredes ventriculares esquerdas dos corações com CMDIsq ou CMDId não se altera quando comparada aos corações normais; 5) A dilatação transversal da câmara ventricular esquerda nos corações com CMD não se dá de forma proporcional ao longo do seu eixo longitudinal, sendo mais acentuada nas regiões basal e equatorial; 6) A câmara ventricular esquerda nos corações com CMD de origem isquêmica ou idiopática não apresenta formato esférico. / BACKGROUND: Anatomic knowledge is the cornerstone for the development of surgical and diagnostic image techniques and for understanding pathological entities. Understanding cardiac anatomy is essential for understanding cardiac remodeling in both ischemic and idiopathic dilated cardiomyopathies. Dysfunction in the physiological relationship between the morphology of left ventricle and its mitral ring plays an important role in the cardiac insufficiency etiopathogenesis. OBJECTIVES: 1) To compare morphology of left ventricle and its mitral ring among normal, ischemic and idiopathic dilated cardiomyophatic anatomic specimens; 2) To compare intra specimen ventricular segmental perimeters relationships between normal and dilated specimens; 3) To verify the presence of the spheroid shape of left ventricular chamber in dilated specimens. METHODS: It was analyzed 43 specimens of human hearts, classified in three groups: normal (n=10), dilated due to ischemic (n=15) or idiopathic cardiomyopathies (n=18). Several lengths were measured: the length from the posterior atrioventricular sulcus to the ventricular apex in the intact specimen; followed by three sequential transversal ventricular slicing in the basal, equatorial and apical level. Digital pictures were taken from these slices, in order to be analyzed in a computer assisted fashion. Internal perimeter and ventricular walls width of each slice were measured, as well the mitral ring perimeter. The three intra group perimeters were compared and correlated between themselves. Basal, equatorial and apical perimeter of each group was compared to their correspondent pairs inter groups. Regarding intra group relationships, for a given group, each slice perimeter was measured and considered as a percentage of the equatorial slice (index). This percentage was compared inter groups. Three perimeters were evaluated in both dilated groups, each one was compared to its expected value when considering left ventricular chamber as a perfect sphere (hypothesis). Measurements and index statistical analysis was performed. RESULTS: Mitral ring perimeter was longer than the NORMAL group only in ischemic group. There was a low correlation coefficient between mitral ring perimeter and ventricular segmental perimeters in both dilated groups. Longitudinal length from the left atrioventricular sulcus until the apex was similar in dilated specimens and higher compared to the normal group. Regarding sequential perimeters of ventricular slices in the normal specimens, the equatorial perimeter was as long as the basal ones, but both of them longer than the apical one. In the other hand, for dilated specimens, equatorial diameter was the longest one and apic al the smallest one. Comparing ventricular slices perimeters between dilated groups, all the perimeters lengths were longer in the idiopathic group than in the ischemic one. All the ventricular slices perimeters were longer for both dilated groups than for the normal group. There was no difference of ventricular wall width between groups. The proposed index of proportional perimeter: considering the proportion between basal and equatorial perimeter, there was no difference between any groups; but considering the proportion between apical and equatorial perimeter, dilated specimens displayed a lower index when compared to normal specimens. All the observed ventricular slice perimeters were smaller than the hypothetical (sphere) expected ones in both dilated groups. CONCLUSIONS: 1) Left atrioventricular ring dilatation occurs in ischemic dilated cardiomyopathy and it is independent of the dilatation of segments (apical, basal and equatorial) ventricular; 2) Longitudinal left ventricular dilatation is similar between dilated groups; 3) A transversal ventricular chamber dilatation was observed in dilated diseases and it is greater in the idiopathic disease; 4) The left ventricular wall widths in both dilated cardiomyopathies were similar to normal hearts; 5) Transversal dilatation of left ventricular chamber in both dilated cardiomyopathies is not proporcional along their longitudinal axis because it is more accentuated in equatorial and basal regions; 6) Left ventricular chamber in both dilated cardiomyopathies does not keep spherical shape.

INTRODUÇÃO: O conhecimento anatômico desempenha importante papel no desenvolvimento de técnicas diagnósticas e cirúrgicas. Com esse objetivo, na área cardiológica, se mostra fundamental para o entendimento do processo de remodelamento cardíaco que acompanha as cardiomiopatias dilatadas (CMD) tanto isquêmicas (CMDIsq) como idiopáticas (CMDId), de modo particular do ventrículo esquerdo (VE) e sua correlação com alterações do anel atrioventricular esquerdo, levando a graus variáveis de insuficiência cardíaca (IC). OBJETIVOS: Os objetivos desta pesquisa são: 1) Obter medidas do anel atrioventricular esquerdo (mitral) e do ventrículo esquerdo em corações normais, com CMDIsq ou CMDId, comparando-as entre si; 2) Analisar a proporcionalidade entre segmentos da câmara ventricular esquerda dos corações com CMDIsq ou CMDId em relação ao normal; 3) Determinar a esfericidade ou não da câmara ventricular esquerda nos corações com CMDIsq ou CMDId. MÉTODO: Foram analisados 43 corações humanos, divididos em três grupos: NORMAL (n=10), CMDIsq (n=15) e CMDId (n=18). De posse da medida da distância do sulco atrioventricular posterior até o ápice do VE, foram realizados cortes transversais baso-apicais seqüenciais e, após digitalização dos mesmos, por meio de método computadorizado, foram obtidas medidas perimetrais e espessura das paredes. Empregando-se o mesmo método, mensurou-se o perímetro do anel mitral. Foram criados índices de proporção porcentual entre os perímetros dos segmentos provenientes dos cortes do VE, comparando-os intergrupos. Nos dilatados os perímetros segmentares mensurados foram comparados com os perímetros esperados se considerássemos a câmara ventricular como uma esfera perfeita. Realizou-se a análise estatística dessas medidas e índices. RESULTADOS: O perímetro do anel mitral teve o seguinte resultado: somente o grupo CMDIsq teve média significativamente maior que o grupo NORMAL e houve baixo coeficiente de correlação com os perímetros ventriculares segmentares nos corações dilatados. Distância do sulco atrioventricular até o ápice do VE: CMDId = CMDIsq > NORMAL. Perímetros segmentares ventriculares basais (PerB), equatoriais (PerE) e apicais (PerA): grupo NORMAL-> PerE = PerB > PerA; grupos CMDId e CMDIsq- > PerE > PerB > PerA, sendo que o grupo CMDId teve essas 3 medidas maiores que o grupo CMDIsq e ambos tiveram essas 3 medidas maiores que o grupo NORMAL. Nos 3 grupos as medidas de espessura das paredes ventriculares foram iguais estatisticamente. O índice de proporção perimetral PerB/PerE foi igual nos 3 grupos, enquanto o índice PerA/PerE foi igual entre os corações dilatados, mas em ambos foi menor que no grupo NORMAL. Todos perímetros segmentares ventriculares dos corações dilatados foram menores do que os calculados segundo a fórmula da esfera. CONCLUSÕES: 1) O anel atrioventricular esquerdo dilata-se na CMDIsq, sendo essa alteração independente da dilatação dos três segmentos do VE; 2) Os corações com CMDId e CMDIsq desenvolvem uma similar dilatação longitudinal do VE; 3) Ocorre uma dilatação trans versal do VE nessas afecções, sendo essa maior nos corações com CMDId; 4) A espessura das paredes ventriculares esquerdas dos corações com CMDIsq ou CMDId não se altera quando comparada aos corações normais; 5) A dilatação transversal da câmara ventricular esquerda nos corações com CMD não se dá de forma proporcional ao longo do seu eixo longitudinal, sendo mais acentuada nas regiões basal e equatorial; 6) A câmara ventricular esquerda nos corações com CMD de origem isquêmica ou idiopática não apresenta formato esférico. / BACKGROUND: Anatomic knowledge is the cornerstone for the development of surgical and diagnostic image techniques and for understanding pathological entities. Understanding cardiac anatomy is essential for understanding cardiac remodeling in both ischemic and idiopathic dilated cardiomyopathies. Dysfunction in the physiological relationship between the morphology of left ventricle and its mitral ring plays an important role in the cardiac insufficiency etiopathogenesis. OBJECTIVES: 1) To compare morphology of left ventricle and its mitral ring among normal, ischemic and idiopathic dilated cardiomyophatic anatomic specimens; 2) To compare intra specimen ventricular segmental perimeters relationships between normal and dilated specimens; 3) To verify the presence of the spheroid shape of left ventricular chamber in dilated specimens. METHODS: It was analyzed 43 specimens of human hearts, classified in three groups: normal (n=10), dilated due to ischemic (n=15) or idiopathic cardiomyopathies (n=18). Several lengths were measured: the length from the posterior atrioventricular sulcus to the ventricular apex in the intact specimen; followed by three sequential transversal ventricular slicing in the basal, equatorial and apical level. Digital pictures were taken from these slices, in order to be analyzed in a computer assisted fashion. Internal perimeter and ventricular walls width of each slice were measured, as well the mitral ring perimeter. The three intra group perimeters were compared and correlated between themselves. Basal, equatorial and apical perimeter of each group was compared to their correspondent pairs inter groups. Regarding intra group relationships, for a given group, each slice perimeter was measured and considered as a percentage of the equatorial slice (index). This percentage was compared inter groups. Three perimeters were evaluated in both dilated groups, each one was compared to its expected value when considering left ventricular chamber as a perfect sphere (hypothesis). Measurements and index statistical analysis was performed. RESULTS: Mitral ring perimeter was longer than the NORMAL group only in ischemic group. There was a low correlation coefficient between mitral ring perimeter and ventricular segmental perimeters in both dilated groups. Longitudinal length from the left atrioventricular sulcus until the apex was similar in dilated specimens and higher compared to the normal group. Regarding sequential perimeters of ventricular slices in the normal specimens, the equatorial perimeter was as long as the basal ones, but both of them longer than the apical one. In the other hand, for dilated specimens, equatorial diameter was the longest one and apic al the smallest one. Comparing ventricular slices perimeters between dilated groups, all the perimeters lengths were longer in the idiopathic group than in the ischemic one. All the ventricular slices perimeters were longer for both dilated groups than for the normal group. There was no difference of ventricular wall width between groups. The proposed index of proportional perimeter: considering the proportion between basal and equatorial perimeter, there was no difference between any groups; but considering the proportion between apical and equatorial perimeter, dilated specimens displayed a lower index when compared to normal specimens. All the observed ventricular slice perimeters were smaller than the hypothetical (sphere) expected ones in both dilated groups. CONCLUSIONS: 1) Left atrioventricular ring dilatation occurs in ischemic dilated cardiomyopathy and it is independent of the dilatation of segments (apical, basal and equatorial) ventricular; 2) Longitudinal left ventricular dilatation is similar between dilated groups; 3) A transversal ventricular chamber dilatation was observed in dilated diseases and it is greater in the idiopathic disease; 4) The left ventricular wall widths in both dilated cardiomyopathies were similar to normal hearts; 5) Transversal dilatation of left ventricular chamber in both dilated cardiomyopathies is not proporcional along their longitudinal axis because it is more accentuated in equatorial and basal regions; 6) Left ventricular chamber in both dilated cardiomyopathies does not keep spherical shape.

Introdução: A insuficiência cardíaca congestiva (ICC) ocasionada pela cardiomiopatia dilatada idiopática (CMDId) constitui-se em quadro causador de grande impacto na saúde pública, apresentando morbidade e mortalidade significativas, porém muitos aspectos referentes à sua fisiopatologia ainda permanecem desconhecidos, de modo que trabalhos que estudem tais aspectos poderão contribuir para melhor entendimento desta entidade. Objetivos: Avaliar aspectos anatômicos e histológicos de corações com CMDId e compará-los a um grupo controle de corações normais, obtendo-se as medidas dos perímetros dos anéis atrioventriculares direito (AVD) e esquerdo (AVE) e dos ventrículos direito (VD) e esquerdo (VE) bem como a porcentagem por área de fibras colágenas e elásticas dos anéis atrioventriculares direito e esquerdo. Métodos: Foram analisados 13 corações de pacientes que faleceram vítimas de CMDId e 13 corações normais de pacientes que faleceram por causas não relacionadas à doenças cardiovasculares. Os corações foram fixados em formol, dissecados de forma a manter-se apenas os anéis atrioventriculares e a massa ventricular, com posterior laminação desta em segmentos transversais correspondentes a 20%, 50% e 80% da distância compreendida entre o sulco atrioventricular e o ápice ventricular esquerdo. Os cortes assim obtidos foram submetidos à digitalização fotográfica, que permitiu a aferição de ambos os perímetros ventriculares por meio de software específico, tornando possível a comparação de tais medidas entre os grupos e os segmentos. Os anéis atrioventriculares foram posteriormente dissecados, fotografados e medidos digitalmente para aferição das medidas perimetrais a direita e a esquerda, sendo posteriormente enviados ao laboratório de anatomia patológica, sendo realizadas colorações por meio de hematoxilinaeosina, picrossírius e resorcina fuccina oxidada, permitindo estudo das fibras colágenas e elásticas. Resultados: Com relação aos segmentos ventriculares, notou-se que no grupo CMDId ocorre dilatação nos segmentos apical, equatorial e basal, tanto a direita quanto a esquerda A medida do AVD foi maior no grupo CMDId , não havendo diferença estatisticamente significante com relação ao AVE entre os dois grupos. Com relação ao percentual por área de fibras colágenas, tanto o AVE quanto o AVD apresentaram percentagem de fibras menor no grupo CMDId em relação ao grupo normal. Com relação ao percentual por área de fibras elásticas, não houve diferença entre os grupos. Conclusões: Ocorre alteração da geometria ventricular com dilatação tanto a direita quanto a esquerda no grupo CMDId, porém com comportamento distinto entre o VE e o VD. O anel atrioventricular esquerdo não se dilata, ao contrário do direito, a despeito do fato de em ambos ocorrer diminuição da área total de colágeno, sugerindo que o mecanismo de dilatação possa apresentar particularidades oriundas de diferenças estruturais e pressóricas em ambos os ventrículos / Introduction: Congestive heart failure caused by idiopathic dilated cardiomyopathy causes great impact on public health, with significant morbidity and mortality, but many aspects related to its pathophysiology remain unknown, so further studies can contribute to better understanding of this entity. Objectives: To evaluate anatomical and histological aspects of hearts from patients who died victims of idiopathic dilated cardiomyopathy and compare them to a control group, to evaluate the behavior of the perimeters of the right and left atrioventricular rings and left and right ventricles and to compare the percentage area of collagen and elastic fibers of the right and left atrioventricular rings in both groups. Methods: We analyzed 13 hearts of patients who died from idiopathic dilated cardiomyopathy and 13 normal hearts from patients who died of causes not related to cardiovascular disease. The hearts were fixed in formalin, dissected in order to keep only the ventricular mass and atrioventricular rings, with subsequent lamination of segments corresponding to 20%, 50% and 80% of the distance between the atrioventricular groove and the left ventricular apex . The sections obtained were subjected to photo scanning, which allowed the measurement of ventricular perimeters by means of specific software, making it possible to compare these measures between groups and segments. The atrioventricular rings were then dissected, photographed and measured digitally to evaluate the right and left perimeters, later being sent to the pathology laboratory, and stained by hematoxylin-eosin, picrosirius and oxidized resorcin fuccin, enabling study of collagen and elastic fibers. Results: Regarding to ventricular segments, it was noted that in the idiopathic dilated cardiomyopathy group dilation occurs in the apical, equatorial and basal segments, at both sides, and the right atrioventricular ring measurement was higher in idiopathic dilated cardiomyopathy group, with no statistically significant difference in the left side between the two groups. With respect to the percentage by area of collagen fibers, both the left and the right sides had lower percentage of fibers in the idiopathic dilated cardiomyopathy group compared to the normal group. With respect to the percentage by area of elastic fibers, there was no difference between the groups. Conclusions: There is a change in ventricular geometry in idiopathic dilated cardiomyopathy group, but with different behavior between the left and right ventricles. The left atrioventricular ring does not dilate, in spite of the fact that in both ventricles there is lowering of the total area of collagen, suggesting that the mechanism of dilation may present peculiarities arising from structural differences and pressure load in both ventricles

Introdução: A insuficiência cardíaca congestiva (ICC) ocasionada pela cardiomiopatia dilatada idiopática (CMDId) constitui-se em quadro causador de grande impacto na saúde pública, apresentando morbidade e mortalidade significativas, porém muitos aspectos referentes à sua fisiopatologia ainda permanecem desconhecidos, de modo que trabalhos que estudem tais aspectos poderão contribuir para melhor entendimento desta entidade. Objetivos: Avaliar aspectos anatômicos e histológicos de corações com CMDId e compará-los a um grupo controle de corações normais, obtendo-se as medidas dos perímetros dos anéis atrioventriculares direito (AVD) e esquerdo (AVE) e dos ventrículos direito (VD) e esquerdo (VE) bem como a porcentagem por área de fibras colágenas e elásticas dos anéis atrioventriculares direito e esquerdo. Métodos: Foram analisados 13 corações de pacientes que faleceram vítimas de CMDId e 13 corações normais de pacientes que faleceram por causas não relacionadas à doenças cardiovasculares. Os corações foram fixados em formol, dissecados de forma a manter-se apenas os anéis atrioventriculares e a massa ventricular, com posterior laminação desta em segmentos transversais correspondentes a 20%, 50% e 80% da distância compreendida entre o sulco atrioventricular e o ápice ventricular esquerdo. Os cortes assim obtidos foram submetidos à digitalização fotográfica, que permitiu a aferição de ambos os perímetros ventriculares por meio de software específico, tornando possível a comparação de tais medidas entre os grupos e os segmentos. Os anéis atrioventriculares foram posteriormente dissecados, fotografados e medidos digitalmente para aferição das medidas perimetrais a direita e a esquerda, sendo posteriormente enviados ao laboratório de anatomia patológica, sendo realizadas colorações por meio de hematoxilinaeosina, picrossírius e resorcina fuccina oxidada, permitindo estudo das fibras colágenas e elásticas. Resultados: Com relação aos segmentos ventriculares, notou-se que no grupo CMDId ocorre dilatação nos segmentos apical, equatorial e basal, tanto a direita quanto a esquerda A medida do AVD foi maior no grupo CMDId , não havendo diferença estatisticamente significante com relação ao AVE entre os dois grupos. Com relação ao percentual por área de fibras colágenas, tanto o AVE quanto o AVD apresentaram percentagem de fibras menor no grupo CMDId em relação ao grupo normal. Com relação ao percentual por área de fibras elásticas, não houve diferença entre os grupos. Conclusões: Ocorre alteração da geometria ventricular com dilatação tanto a direita quanto a esquerda no grupo CMDId, porém com comportamento distinto entre o VE e o VD. O anel atrioventricular esquerdo não se dilata, ao contrário do direito, a despeito do fato de em ambos ocorrer diminuição da área total de colágeno, sugerindo que o mecanismo de dilatação possa apresentar particularidades oriundas de diferenças estruturais e pressóricas em ambos os ventrículos / Introduction: Congestive heart failure caused by idiopathic dilated cardiomyopathy causes great impact on public health, with significant morbidity and mortality, but many aspects related to its pathophysiology remain unknown, so further studies can contribute to better understanding of this entity. Objectives: To evaluate anatomical and histological aspects of hearts from patients who died victims of idiopathic dilated cardiomyopathy and compare them to a control group, to evaluate the behavior of the perimeters of the right and left atrioventricular rings and left and right ventricles and to compare the percentage area of collagen and elastic fibers of the right and left atrioventricular rings in both groups. Methods: We analyzed 13 hearts of patients who died from idiopathic dilated cardiomyopathy and 13 normal hearts from patients who died of causes not related to cardiovascular disease. The hearts were fixed in formalin, dissected in order to keep only the ventricular mass and atrioventricular rings, with subsequent lamination of segments corresponding to 20%, 50% and 80% of the distance between the atrioventricular groove and the left ventricular apex . The sections obtained were subjected to photo scanning, which allowed the measurement of ventricular perimeters by means of specific software, making it possible to compare these measures between groups and segments. The atrioventricular rings were then dissected, photographed and measured digitally to evaluate the right and left perimeters, later being sent to the pathology laboratory, and stained by hematoxylin-eosin, picrosirius and oxidized resorcin fuccin, enabling study of collagen and elastic fibers. Results: Regarding to ventricular segments, it was noted that in the idiopathic dilated cardiomyopathy group dilation occurs in the apical, equatorial and basal segments, at both sides, and the right atrioventricular ring measurement was higher in idiopathic dilated cardiomyopathy group, with no statistically significant difference in the left side between the two groups. With respect to the percentage by area of collagen fibers, both the left and the right sides had lower percentage of fibers in the idiopathic dilated cardiomyopathy group compared to the normal group. With respect to the percentage by area of elastic fibers, there was no difference between the groups. Conclusions: There is a change in ventricular geometry in idiopathic dilated cardiomyopathy group, but with different behavior between the left and right ventricles. The left atrioventricular ring does not dilate, in spite of the fact that in both ventricles there is lowering of the total area of collagen, suggesting that the mechanism of dilation may present peculiarities arising from structural differences and pressure load in both ventricles