Postmortem imaging in congenital heart disease: preliminary experience.

BACKGROUND: Despite the importance of the autopsy for quality improvement, autopsy rates have declined dramatically in recent decades due to poor acceptance by families and physicians and high costs to institutions. PURPOSE: To compare postmortem imaging (PMI) with autopsy in patients with congenital heart defects to see if PMI could substitute in some or all cases and to compare costs of the two methods. MATERIAL AND METHODS: Ten patients with congenital heart disease dying in hospital during the study period in whom an autopsy was planned underwent PMI using postmortem magnetic resonance imaging (PMMRI) (6 patients) and postmortem computed tomographic angiography (PMCTA) (10 patients) with permission of the family. Four patients were excluded from PMMR because of metal ECMO cannulas. PMI was interpreted before autopsy using an organ system checklist and results compared to autopsy. The costs of each method were tracked. RESULTS: When both PMMR and PMCTA were performed the PMI findings corresponded closely with autopsy. PMI correctly diagnosed the principal heart defects in all six cases and correctly imaged central vessels, heart valves and chambers, brain, abdominal organs, and bone. Weak points were visualization of the coronary arteries and distinguishing postmortem pulmonary atelectasis from lung pathology. The cause of death by PMI matched autopsy findings in 5/6 cases in which both PMMR and PMCTA were performed and was incomplete in the other five cases. The cost of PMI was about 15% lower than the cost of autopsy. CONCLUSION: PMI provided most gross anatomic cardiac diagnoses available by autopsy in our series of patients with congenital heart defects and the cost appears to be lower.

Giant aneurysm of the atrial appendages in infants.

This case series describe two patients with giant aneurysms of the atrial appendages. This report discusses the clinical symptoms, imaging modalities, indications for surgical intervention, and histology of atrial appendage aneurysms.

Preliminary experience with porcine intestinal submucosa (CorMatrix) for valve reconstruction in congenital heart disease: histologic evaluation of explanted valves.

OBJECTIVE: We compared the histologic findings in explanted CorMatrix (9 patients) and autologous pericardium (9 patients) used for valvuloplasty of the aortic (7 patients) and/or mitral (11 patients) valve in patients with congenital heart defects. METHODS: We used standard tissue stains and immunohistochemistry to identify the inflammatory cell type. RESULTS: CorMatrix was associated with an intense inflammatory response in the surrounding native tissue, extending into CorMatrix in 8 of 9 cases, continuing to the longest follow-up point (9 months). The typical response included macrophages and giant cells in contact with the material, surrounded by lymphocytes, macrophages, plasma cells, and eosinophils. The thickness of the residual CorMatrix material was 280 to 300 µm, similar to the nominal thickness at implantation and unrelated to the implantation duration. Only at the longest follow-up interval was any significant resorption of CorMatrix material evident. A neointima had formed on the surface of CorMatrix, increasing in thickness with the period in situ. Mild cellular infiltration of CorMatrix was noted in all cases; however, in no case, did it appear that CorMatrix was being remodeled into tissue resembling a 3-layered native valve. In contrast, a near absence of any inflammatory reaction was seen and no eosinophilia associated with autologous pericardium was present, irrespective of the duration in situ. Furthermore, we observed more tissue infiltration, remodeling, vascularization, and neointima formation with autologous pericardium. CONCLUSIONS: Although CorMatrix used for valve repair induced an intense inflammatory response, little or no remodeling to form tissue resembling a 3-layered native valve was seen at ≤9 months after implantation.

Effect of percutaneous mitral vavuloplasty on pregnant mother and foetus--a tertiary care hospital experience from a developing country.

UNLABELLED: This study evaluated the short and long-term consequences of Percutaneous Mitral Valvuloplasty (PMV) in pregnant patients and their offspring, in a tertiary care setting, Karachi, Pakistan. The hospital database was used to retrieve all patients who underwent PMV during pregnancy in the period 1998-2007. The follow up data of the patients and the born children were obtained from the hospital records and also by contacting the patients via phone. Six patients underwent PMV but follow-up was available for 5 patients only. All 5 patients were admitted due to severe mitral stenosis with symptoms of dyspnea and palpitation. Mean age was 27 +/- 5.3 years with a mean gestational age at the time of procedure of 22.20 +/- 1.6 weeks. The mean valve area increased from 0.94 +/- 0.22 cm2 preoperatively to 1.62 +/- 0.50 cm2 post-operatively. The ejection fraction changed from a mean of 50 +/- 11.7% to 56 +/- 2.2%. There were no maternal deaths, abortions or stillbirths. Developmental milestones were achieved at the appropriate ages in all babies. PMV appears to be a safe and effective intervention for patients with severe MS during pregnancy. KEYWORDS: Mitral stenosis, Percutaneous Mitral