Pathomorphology of the endocrine heart
Our present investigations show that the heart with its myoendocrine cells will probably become an important tool in the evaluation of the status of cardiovascular and renal diseases. Tissue of the endocrine heart, blood plasma, and urine from patients undergoing open heart surgery for aorto-coronary bypass and correction of valve and septum diseases was examined. The right auricular myoendocrine cells were studied with immunohistochemistry and electron microscopy for cardiac hormones (Cardiodilatin = CDD 99–126/alpha human ANP). Depending on the status of the patient, differing quantities of CDD-IR (Cardiodilatin immunoreactivity) in the myoendocrine cells were detected by light microscopy, which is confirmed by the granularity or, by autophagolytic processes as seen in the electron microscope. Furthermore, pre- and postoperative blood samples as well as 24 h urine samples were analyzed by radioimmunoassay to measure the concentrations of CDD 99–126/alpha hANP. The concentrations of CDD/ANP measured by radioimmunoassay in plasma and urine samples vary according to different heart diseases. The highest concentrations were obtained in patients with mitral valve diseases (plasma: 67.3 +/- 31.9 fmol/ml, urine: 138.1 +/- 42.6 fmol/ml and aorto-coronary bypass patients with hypertension (plasma: 50.1 +/- 18.5, urine: 93 +/- 25.9 fmol/ml). Similar conditions of plasma and urine samples were detected in normotensive ACB-patients (plasma: 27.7 +/- 9.3, urine: 48.9 +/- 13.7 fmol/ml) and patients with aortic stenosis (plasma: 15.7 +/- 5.9, urine: 43.7 +/- 21.7). Blood and urine samples were also examined by high pressure liquid chromatography (HPLC) to determine the molecular forms of their circulating CDD/hANP, which were then compared. The present work shows that pathomorphological analysis plays an important role in the diagnosis of cardiovascular diseases.
Since the discovery of the heart as an endocrine organ, its role in the regulation of blood pressure and electrolyte-water threshold (3,9) has become evident. In spite of numerous publications which show the importance of the endocrine heart (1,2,8) there is little information about ultrastructural changes of the atrial endocrine organ during various cardiovascular diseases. Thus, we studied the parameters available for diagnostic and prognostic tools in patients undergoing cardiac surgery, i.e., aorta-coronary bypass, valve replacement or repair, and interventions in cases of cardiac malformations.
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