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The postoperative pathology of congenital heart disease

Published online by Cambridge University Press:  19 August 2008

Robert H. Anderson  and
Siew Yen Ho
Robert H. Anderson*
Affiliation:
From the Department of Paediatrics, National Heart & Lung Institute, London
Siew Yen Ho
Affiliation:
From the Department of Paediatrics, National Heart & Lung Institute, London
*
Correspondence to Dr. Robert H. Anderson, Department of Paediatrics, National Heart and Lung Institute, Dovehouse Street, London SW36LY, United Kingdom. Tel. 44-71-351-8940; Fax. 44-71-351-8230
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Abstract

The role of the pathologist is changing with regard to the assessment of postoperative congenital heart disease. Whereas, in the past, the access to autopsied hearts provided the opportunity for detailed description and classification, nosologic details of cardiac malformations are now largely agreed. While a detailed analysis of the lesion remains an integral part of the pathologist's task, future advances will now largely be dictated by careful analysis of the effects of cardiac surgery. Such analysis can be divided into early and late phases. When assessing the specimen from a death occurring in the operating room or in the immediate postoperative period, the pathologist must examine carefully the operative incisions, and the correctness of the surgical procedure. Proper assessment of the procedure will necessitate removal of patches and pathways constructed by the surgeon, having documented carefully the location of sutures used to secure the foreign materials. The autopsy must also include assessment of the organs in the rest of the body, particularly the lungs, and must not ignore the immediate effect of the operative procedure on myocardial status. In the late phase, while again assessing in detail the access to the heart and the procedures employed during surgical correction, the pathologist will take care to evaluate the long-term effects of the procedure on the valves of the heart, the myocardium, the pulmonary vasculature and the other organs. At this stage, care should also be taken to ensure that late scarring does not involve the conduction tissues. Particular care will be needed when assessing the efficacy and durability of prosthetic materials inserted into the heart. Most of these steps will be undertaken intuitively by the pathologist, but interest in cardiac pathology as a specialty seems to be waning. The clinician can combat this trend by ensuring that all cases dying after operative procedures are obtained for autopsy, and by encouraging the pathologist to become involved in this fascinating area.

Keywords

Cardiac pathologycongenital heart diseasecardiac surgery
Type
Review and Comment
Information
Cardiology in the Young , Volume 3 , Issue 2 , April 1993 , pp. 147 - 157
Copyright
Copyright © Cambridge University Press 1993

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