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. 2022 Nov 12;26(2):233–248. doi: 10.1007/s10456-022-09860-7

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 5 — Visualization of ultrastructurally detectable thrombi (uTh) in COVID-19 hearts. A H&E staining of a thrombus in a smaller blood vessel in a field of interstitial fibrosis. B Immunohistochemical staining against activated fibrin displayed the formation of thrombus in a larger blood vessel. C Occasionally, small intracapillary megakaryocytes were observed in COVID-19 autopsy tissue, magnification 400× (COVID-19 patient ID 9). D, E Scanning electron micrograph of microvascular corrosion casting depicting numerous irregularly dilated and blind-ending vessels with vanishing microvascular hierarchy and micro-extravasation (black arrowheads) indicative for microangiopathy in COVID-19 heart tissue. Cardiac involvement of COVID-19 demonstrates caliber changes with dilated segments and focal vasoconstrictions (red arrowheads). The expansion of vascular plexus by intussusception (yellow arrowheads) is distinctly occurring in the dilated vessel segments, preferably on sites of vessel branching. Scale bars 100 µm. F Quantification of visible microthrombi (indicated by premature obliteration of the capillary network (approximate diameter 1–3 µm)) and intussusceptive neoangiogenesis (indicated by the formation of intussusceptive pillars) in COVID-19 and lymphocytic non-influenza myocarditis compared to healthy control tissue. G Correlation between the presence of uTh formation and the number of intussusceptive pillar formation in COVID-19 and lymphocytic non-influenza myocarditis compared to non-infected control tissue