Heart transplants

• describe the epicardial surface-fat, petechiae, adhesions.

• use method of cutting appropriate to the specimen:

- apical four chamber cut - cut longitudinally from apex to base bivalving both ventricles and bisecting the tricuspid and mitral valves. This method is useful in cutting specimens showing dilated cardiomyopathy.

- serial sectioning - cut heart transversely beginning at the apex and extending to the level of the mitral valve at approximately 1 to 2 cm intervals. The base of the heart may be cut longitudinally or opened according to the lines of flow. This method is useful in ischaemic heart disease.

• describe each ventricle - hypertrophy, dilatation, fibrosis, infarcts, trabeculation, papillary muscles, mural thrombus.

• measure the thickness of the ventricular walls (mm).

• describe the atria and any endocardial lesions.

• dissect atherosclerotic coronary arteries, fix and decalcify them, section transversely at 3-5 mm intervals.

• describe coronary arteries - presence of right or left dominance, thrombi, atheroma, locations.

• describe by-pass grafts if present - type, location, presence of thrombus, atheroma. Blocks for histology:

• take sections from the left and right ventricular walls, the ventricular septum, native coronary arteries, bypass grafts, other lesions.

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