Multifocal ischemic necroses of varying age (MINOVA): A distinctive form of atherosclerotic heart disease

While reviewing the cardiac histopathology and the postmortem arteriography of patients studied at autopsy, a collection of findings was identified in a small proportion of those with ischemic heart disease. These included varying degrees of hypertrophy and left ventricular dilation and severe multifocal atherosclerotic obstruction of the coronary arteries by gross examination. Histology showed multiple small foci of coagulation or contraction-band necrosis in a circumferential, subendocardial pattern; focal replacement fibrosis of varying ages and size; focal atrophy or vacuolization (a marker of chronic ischemia) of surviving myocytes; and marked dilation of the subendocardial vasculature. This collection of findings described here is termed multifocal ischemic necroses of varying age (MINOVA). Review of patient histories showed that the clinical suspicion for the degree of ischemic heart disease did not correlate well with the severity of the pathological findings.