Info

and variable wall thinning.

hypercellularity); focal lymphocyte.

Adapted from Edwards (15).

Adapted from Edwards (15).

been described, although reperfusion alters the pattern (15,57, 58). All current methods of detecting early myocardial infarctions have recently been reviewed (52).

If ischemic heart disease is suspected as the cause of death, at least three histologic sections should be taken at the mid-ventricular level and include the anteroseptal, anterolateral, and inferior walls, with both mitral papillary muscles. If mottled or obviously infarcted areas are identified grossly, these should also be evaluated. Sections from inferoseptal infarcts should also include the inferior wall of the right ventricle.

VALVULAR HEART DISEASE For cases of suspected endocarditis, vegetations can be cultured as described in Chapter 9. Other disorders of native or prosthetic valves are best demon strated using a combination of the short-axis and base-of-heart methods of dissection (see Fig. 3-5B). For aortic and mitral valve disease, the left ventricular long-axis approach can also be used (see Fig. 3-4B). For the distinguishing features of various prosthetic valves, see Table 3-3 (59-62).

For microscopic examination of infected valves, large or multiple sections should be taken to increase the likelihood of detecting organisms. After treatment with antibiotics, a Grocott methenamine silver stain may better demonstrate dead bacteria in the vegetations than a Gram stain.

Left-sided valve disease may be associated with myocardial ischemia, due to inadequate coronary perfusion, coronary obstruction from embolic valvular vegetations, or injury to a coronary

Table 3-3 Types of Prosthetic Heart Valves Likely to Be Encountered at Autopsy

Mechanical Bioprosthetic

Table 3-3 Types of Prosthetic Heart Valves Likely to Be Encountered at Autopsy

Mechanical Bioprosthetic

Bileaflet

Porcine Aortic Valve

CarboMedics

Carpentier-Edwards

St. Jude

Hancock

Tilting Disk

Bovine Pericardial Valve

Bjork-Shiley

Carpentier-Edwards

Lillehei-Kaster

Ionecu-Shiley

Medtronic-Hall

Cadaveric Homograft Valve

Omniscience

CryoLife

Sorin

Red Cross

Caged Ball

Autograft

Starr-Edwards

Ross Procedurea

a Involves using the patient's own pulmonary valve in the aortic position.

a Involves using the patient's own pulmonary valve in the aortic position.

Table 3-4

Modified Heath-Edwards Classification of Plexogenic Pulmonary Hypertension in Congenital Cardiac Left-to-Right Shunts

Table 3-4

Modified Heath-Edwards Classification of Plexogenic Pulmonary Hypertension in Congenital Cardiac Left-to-Right Shunts

Grade

Lesion

Reversible

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