M Smith1, D E Trummel, M Dolz, S J Cina. 1. Combined Pathology Residency Program, Wilford Hall Medical Center/Brooke Army Medical Center, San Antonio, Texas.
Abstract
OBJECTIVE: To assess the adequacy of perfusion of the heart at autopsy with a gastrograffin and dye mixture to obtain rapid postmortem angiograms while simultaneously documenting the vascular distribution of the myocardium. BACKGROUND: Postmortem coronary angiography is occasionally used in the evaluation of suspected cardiac deaths. Angiography provides legal documentation and can serve to guide subsequent cardiac dissection. Multiple techniques have been suggested in the literature for coronary angiography using infusion of radio-opaque silicone or gelatin. These techniques are cumbersome and require equipment generally not available in autopsy suites. METHODS: Following removal of the heart, a mixture of gastrograffin and colored dyes is injected into each coronary artery via a syringe. The coronary arteries are ligated and radiographs are obtained. After fixation, the heart is dissected in the usual manner. RESULTS: Adequate postmortem coronary angiograms are routinely obtained with this method. The coronary arterial distribution within the myocardium is easily documented at both the gross and microscopic levels because of the presence of differential coloration. CONCLUSIONS: The aforementioned technique using a gastrograffin and dye mixture provides a simplified approach to postmortem angiography. The novelty of the procedure stems from the low cost, ease of implementation, dual ability to assess vascular anatomy radiologically (gastrograffin), and gross distribution and histologic findings of dependent tissue using the light microscope (colored dye). This technique is inexpensive, rapid, and easily used, making it more suitable for general hospital practice and medical examiners' offices than previously described methods.
OBJECTIVE: To assess the adequacy of perfusion of the heart at autopsy with a gastrograffin and dye mixture to obtain rapid postmortem angiograms while simultaneously documenting the vascular distribution of the myocardium. BACKGROUND: Postmortem coronary angiography is occasionally used in the evaluation of suspected cardiac deaths. Angiography provides legal documentation and can serve to guide subsequent cardiac dissection. Multiple techniques have been suggested in the literature for coronary angiography using infusion of radio-opaque silicone or gelatin. These techniques are cumbersome and require equipment generally not available in autopsy suites. METHODS: Following removal of the heart, a mixture of gastrograffin and colored dyes is injected into each coronary artery via a syringe. The coronary arteries are ligated and radiographs are obtained. After fixation, the heart is dissected in the usual manner. RESULTS: Adequate postmortem coronary angiograms are routinely obtained with this method. The coronary arterial distribution within the myocardium is easily documented at both the gross and microscopic levels because of the presence of differential coloration. CONCLUSIONS: The aforementioned technique using a gastrograffin and dye mixture provides a simplified approach to postmortem angiography. The novelty of the procedure stems from the low cost, ease of implementation, dual ability to assess vascular anatomy radiologically (gastrograffin), and gross distribution and histologic findings of dependent tissue using the light microscope (colored dye). This technique is inexpensive, rapid, and easily used, making it more suitable for general hospital practice and medical examiners' offices than previously described methods.
Authors: Jonas Christoph Apitzsch; Saskia Westphal; Tobias Penzkofer; Christiane Katharina Kuhl; Ruth Knüchel; Andreas H Mahnken Journal: PLoS One Date: 2014-04-23 Impact factor: 3.240