Diapositiva 1

HOW TO DIAGNOSE A SCDAT AUTOPSYDr. Joaquín LucenaForensic Pathology ServiceILM, Seville (SP)

Hippocrates of Cos(460-370 BC)Aphorisms II, 41: "Thosewho are subject tofrequent and severefainting attacks withoutobvious cause diesuddenly."

AUTOPSY OF SCD6. Examine theepicardial surface ofthe ventricles insearch ofaneurysms, scars orfatty infiltration(RV).♂ 65 ys, 620 g

♂ 37 ys. 520 g

AUTOPSY OF SCD7. Inspect the atria insearch ofthrombus, tumormasses(myxomas).Examine the mitraland tricuspidvalves.8. Rule out aorticbicuspid valve. Ruleout tumors (fibroelastopapiloma)

PRIMARY CARDIAC TUMOURSCristina Basso et al. Tumori del Cuore (2004)

LEFT ATRIAL MYXOMA♂ 47 ys. 432 g

Skin SarcomaCARDIAC METASTASIS♂ 23 ys. 355 g

CARDIAC METASTASIS♀ 67 ys, 395 gLymphoma

TRICUSPID VALVE. EBSTEIN´S ANOMALY♂ 51 ys. 725 g

MITRAL VALVE PROLAPSE♀ 57 ys. 430 g♀ 48 ys. 375 g

CONGENITAL BAV STENOSIS♂ 4 ys. 125 g

CONGENITAL BAV STENOSIS2,1 cm2,5 cm♂ 20 ys. 725 g

SUPRAVALVULAR AORTIC STENOSIS0,5 cm♂ 26 ys. 485 g

SENILE CALCIFIC AORTIC STENOSIS2,5 cm2,5 cm♀ 74 ys. 495 g

PROSTHETICVALVE PATHOLOGY

BACTERIAL ENDOCARDITIS♂ 52 ys, black.630 g

ANEURYSM OF VALSALVA SINUS♀ 47 ys. 285 g

ANOMALIES IN THE ORIGIN OF CORONARIESCongenital Anomalies of Coronaries Observed in Cases of SCD· Left main coronary artery from the pulmonary trunk· Left main coronary artery from the right sinusooWith inter-arterial coursePosterior to aorta· Right main coronary from the left sinus· Single coronary ostium (right or left)· High take-offo Located 1 cm above the sino-tubular junctiono Coronary ostia plication· Myocardial Bridge (Tunnel Coronary Artery)o Tunnel greater than 5 mm deep during 2-3 cm de lengtho Common location in the 1/3 middle LAD.o Morphology of surrounded myocardium similar to an sphincter

LEFT MAIN CORONARY FROM THE RIGHT SINUS

ANOMALIES IN THE ORIGIN OF CORONARIESLC arising from thepulmonary trunk♀ 11 ys

ANOMALIES IN THE ORIGIN OF CORONARIES♂ 8 ys. 175 g

ANOMALIES IN THE ORIGIN OF CORONARIES♂ 43 ys. 385 g

ANOMALIES IN THE ORIGIN OF CORONARIES♂ 49 ys. 450 g

ANOMALIES IN THE ORIGIN OF CORONARIES♂ 31 ys. 295 g

ANOMALIES IN THE COURSE OF CORONARIES♂ 47 ys. 420 g

CORONARY DISSECTION♀ 38 ys. 280 g

SMALL INTRAMYOCARDIAL VESSEL DISEASE♂ 23 ys. 305 g

AUTOPSY OF SCD10. Carefully examine theby-pass aortocoronaryand thestents. Cross cuts inthe 4 main trunks ofthe coronary arterieswith a scalpel every3-5 mm.LAD29 ys, ♀

LAD31 ys, ♂LAD34 ys, ♂

LAD51 ys, ♂RCA86 ys, ♂

♀ 62 ys,Tearing of the RCA duringthe introduction of stent

11. Make a coronal cutin the mesocardiumat a distance of 2/3of the apex,especially when amyocardial infarctionis suspected.AUTOPSY OF SCD

MYOCARDIAL INFARCTION

OLD MYOCARDIAL INFARCTION.MURAL THROMBUS52 ys, ♂, 540 g.Traffic AccidentBlood Ethanol: 2.63 g/L

PATHOLOGY OF SCD12. In cases of HCM thesagittal long axis sectionis recommended. Incases of ARVC the heartshould be cut into fourchambers.13. Measure the maximumthickness of the RV andLV (septum and freewall). Transilluminatethe free wall of theventricles to looktranslucent areas.

FOUR CHAMBERS SECTION

1,3 cm1,1 cm0,3 cm♂ 38 ys. 460 g

SAGITTAL LONG AXIS SECTION

0,5 cm3,5 cm♀ 26 ys. 670 g

SECTION OF THE HEART FOLLOWINGTHE BLOODSTREAM

SECTION OF THE HEART FOLLOWINGTHE BLOODSTREAM

AUTOPSY OF SCD14. Take samples for histologyin different areas ofmyocardium and coronaryarteries (anterior, lateraland posterior leftventricular and rightanterior and posteriorseptum). Basic stains: H&E,Masson´s trichrome, elasticfibres.16. Make a clinico–pathological correlationwith final diagnosis. Ifyou discover ahereditary disease, thefamily should beinformed and advisegenetic screening.15. If macro-micro examinationreveals no structural abnormality,study the conduction system.

ADRENAL PATHOLOGY AND THE HEART(19%)

THYROID PATHOLOGY AND THE HEART(23%)

SYSTEMIC REPERCUSSIONOF CARDIOVASCULARPATHOLOGY

LUNG

LIVER

KIDNEY

MORS UBIGAUDETSUCCURREREVITAETHEATRUM ANATOMICUMPATAVINUM, 1594