Clinical pathomorphology

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Changes in muscle fibers, as already indicated, include such phenomena as hypertrophy, atrophy, dystrophy and necrobiosis. These changes are due to the activity of rheumatic process and related metabolic processes.
When the maximum activity may have a significant damage to the muscle fibers, up to necrobiosis with the replacement of granulation tissue, which bears the traits of specificity. On the contrary, with minimal activity rheumatic process on the background of heart failure marked by numerous small pockets necrobiosis and necrosis of muscle fibers metabolic origin, not accompanied active cellular reactions (N. N. Gritsman, V. D. Aknazarova, 1970).
Sclerotic processes are the outcome as the disorganization of the connective tissue and nonspecific inflammation and muscular and vascular changes. As a result, developing deforming scleroses endocardial with the formation of valvular heart disease, until valve calcification, cardiosclerosis different intensity, mainly in the perivascular tissue and connective tissue prosloika, less often in the form of small, irregular foci sclerosis attack on the place of metabolic necrosis finally sclerosis epicardial and very rarely obliteration of the cavity of the heart shirts.
Listed pathological signs of rheumatic heart failure detected at autopsy, and in the study of biopsy material of heart ears, valves and infarction. While there are some peculiarities. So, observed in the ears of rheumatic granuloma localized mainly subendocardiale, in the area glycotope the collapse of collagen, rarely smooth muscle bundles or subendothelial. Along with more rare typical granulomas in the endocardium loops are more common "erased" granuloma (I. Century sparrows and others, 1965). The lack of granulomas often correlates with the degeneration of the cellular elements of the endocardium up to the development of pathology of nuclei in the form of impoverishment of chromatin and Central chromatolysis, which is more typical for systemic lupus and testifies to the true autoimmune reactions.
Nonspecific exudative-proliferative component of inflammation appears, according to biopsies, mainly in the form of individual microprismatic: 1) swelling, proliferation and peeling the endothelial lining of the endocardium; 2) a focal or diffuse lymphohistiocytosis reaction connective tissue cells endocardial; 3) stromal edema attack by the revival of the cellular responses; 4) formation of focal lymphohistiocytic clusters type of allergic granulomas; 5) swelling and proliferation of vascular endothelium. The correlation between morphological and clinical activity is marked more than half of the patients that was reflected and in the frequency of postoperative acute rheumatic process: 57 and 17% respectively in morphologically active and inactive groups (N. N. Gritsman, 1971). Thus, the morphological examination of material obtained during heart operations, the most striking indicator of activity are fresh processes disorganization of the connective tissue, microprismatic nonspecific exudative-proliferative inflammation and less ashoff-talalaevsky granuloma.