The Cardiac Dissection

Abstract

An approach is offered here to assist the pathologist with the actual dissection of the operated heart at autopsy. The challenge to the pathologist is to define any underlying cardiac pathology, recognize changes in morphology brought about by prior surgical intervention, and correlate the gross cardiac findings with the hemodynamic status of the deceased prior to death. Even without detailed clinical records, one can still perform the dissection in a consistent and careful manner that allows an accurate assessment of the heart regardless of postoperative adhesions and complex surgical reconstructions. Developing the plane of dissection between the heart and adherent parietal pericardium should be done with a scalpel, using a methodical technique. As one examines the external surface of the heart, one may observe clues that the surgeon had used cardiopulmonary bypass to rest the heart during surgery and that specific surgical procedures had been performed. By removal of the coronary arteries with any bypass grafts off the heart and subsequent careful examination of the chambers and great vessels of the heart, the pathologist can then begin to understand the “real story.”