Cardiac Transplantation for Cardiac Sarcoidosis With Initial Diagnosis by Examination of the Left Ventricular Apical “Core” Excised for Insertion of a Left Ventricular Assist Device for Severe Chronic Heart Failure

Abstract

Three quinquagenarians who underwent insertion of a left ventricular assist device (LVAD) because of severe heart failure and for whom histologic examination of the left ventricular apical "core" (removed to insert the device) showed noncaseating giant cell granulomas typical of sarcoidosis are described. Later, cardiac transplantation showed widespread sarcoid granulomas in the walls of the right and left ventricles and ventricular septum in 2 patients and extensive scarring in the third patient in the absence of coronary narrowing. Previously, 11 patients who underwent cardiac transplantation because of cardiac sarcoidosis had been reported, and in 1 of these patients, diagnosis was also initially made by examination of the left ventricular core excised at the time of insertion of an LVAD. In conclusion, excision of a portion of left ventricular wall to enable insertion of a therapeutic device (LVAD) can also serve as the means of definitive diagnosis of the underlying cardiac condition.