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The technique used to examine the heart depends on the question asked by those who requested the autopsy.

Most of the pathologists those who carry out autopsies will have learnt the traditional method of opening the heart sequentially in the sequence of blood flow starting at the inferior vena cava.

 Removal of the heart :

- The heart is removed from the lungs by placing a finger through the transverse sinus and then dividing the aorta and main pulmonary artery about 3cm above the aortic valve.

- The pulmonary veins can then be identified and divided.

- Finally the superior vena cava is divided about 2cm above where the crest of the right atrial appendage meets the vena cava, thus preserving the sinus node, and the inferior vena cava is divided close to the diaphragm.

- The pathologist now has an isolated but intact heart in which the venous connections have been confirmed as normal.

                

Examination of the heart: (Traditional Method) -

- Open the right atrium by a cut from the inferior vena cava into the right atrial appendage.

- Open the tricuspid valve laterally down to the apex of the right ventricle.

- Cut from the apex of the right ventricle through the pulmonary valve into the pulmonary artery.

- Join two pulmonary veins across the roof of the left atrium to view the inside of the chamber.

- Cut through the mitral valve orifice laterally down to the apex of the left ventricle.

- Cut from the apex of the left ventricle up through its outflow tract into the aorta.

- There are two variations in this final cut.  It may be made through the anterior cusp of the mitral valve itself or pass anteriorly, leaving a flap of anterior wall of the ventricle hinged on an intact anterior cusp of the mitral valve.

Advantage of this method of examination:  It is possible to examine the structure in detail.

Disadvantage of this method of examination:  Destroy any understanding of the valve function ;  Poorly demonstrating the regional distribution of ischaemic myocardial damage and ventricular shape and of having no correlation with the echocardiographic planes used by clinicians.

Various other techniques are followed the cardiovascular pathologists.

Some pathologists routinely take a transverse 1cm thick slice across the ventricles before opening the rest of the heart.  Such slices allow accurate recording of ventricular shape and of the distribution of ischaemic damage.

A general outline for examining the heart: CLICK

 

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