Cardiac Path Online
A General Outline for Examining the Heart
|1. Note any
pericardial fluid with its nature, and comment if under pressure.
2. Remove heart intact by dividing pulmonary artery and aorta 3cm above valves and dividing superior and inferior vena cava , followed by identifying and dividing four pulmonary veins.
3. Take a transverse slice 1cm thick from across both ventricles at mid-septal level.
Record any infarction (old or recent), its site and record if transmural.
Record mural thrombi.
Carry out enzyme study if indicated.
Measure septal and posterior left ventricular wall thickness and cavity diameter (mean of two planes) for left ventricle.
4. Open left atria (cut from left to a right pulmonary vein) and right atrium (inferior vena cava to atrial appendage).
Check atrial appendages for thrombus.
Wash out post-mortem clot from left and right ventricles. Weigh whole heart.
Record body weight.
5. Examine mitral and tricuspid valves from atria - record any abnormality.
6. Examine aortic and pulmonary valves from above. Check coronary orifices.
7. Make cross-sections across coronary arteries.
8. Take relevant histology blocks.
In general blocks are taken from the short axis slice of ventricles in the horizontal plane, sampling the full thickness of septum, the anterolateral wall including the papillary muscles and the posterior wall.
A block is taken vertically through the left atrium to the left ventricle through the posterior cusp of the mitral valve.
In the right ventricle a block should be taken from the free wall of the right ventricular outflow.
These six blocks, if normal, exclude any myocarditis or cardiomyopathy.
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