Removal Of The Heart From The Chest

INITIAL STEPS Before the autopsy is begun, a radiogram of the chest may be performed (see Chapter 12). The removal of the chest plate has been described in Chapter 1. In patients who have had previous open-heart surgery via a median sternotomy, diffuse pericardial adhesions are common, which requires careful dissection of the heart away from the sternum so as not to disrupt any surgical sites. Pericardial exudate should be cultured (see Chapter 9). Pericardial blood clots should be weighed. If it is necessary to distinguish between blood and serosanguin-ous fluid, a hematocrit can be obtained.

CHOOSING THE METHOD OF REMOVAL Normal hearts and most hearts with acquired disease can be excised separately. In the presence of extracardiac disorders such as pulmonary or esophageal carcinoma or ascending aortic dissection, the heart should be removed with the thoracic organs en bloc (see Chapter 1). For congenital heart disease, the thoracic contents should be removed en bloc, regardless of the age of the patient.

DESCRIPTION OF THE HEART Cardiac size may be normal or enlarged (cardiomegaly) due to hypertrophy or dilatation (or both) and can involve one or more chambers. Overall cardiac shape may be conical (normal), globoid, or irregular (as with a ventricular aneurysm), and one or more chambers may be abnormal in shape. The color of the subepicardial myocardium may be gray with an old infarct, pale with chronic anemia, and mottled or hemorrhagic with an acute infarct or rupture. Left ventricular consistency can be firm (due to hypertrophy, fibrosis, amyloidosis, calcification, or rigor mortis) or soft (due to acute myocardial infarction, myocarditis, dilated cardiomyopathy, or decomposition).

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