Autopsy methods in congenital heart malformations - Influence of prenatal diagnostics on the planning and carrying out of autopsies

As a result of the quality of prenatal ultrasound and the expanded experien ce of prenatal diagnosticians, it is possible to observe congenital heart m alformations in increasingly greater detail and at an ever earlier stage of gestation [4]. Since it is on the basis of ultrasound findings that decisi ons to terminate pregnancies are made, it is of cardinal importance that af ter termination monitoring and confirmation of the prenatal diagnosis be ca rried out. This need can only be adequately met by autopsy. There are diffe rent methods for carrying out autopsies when there is suspicion of a congen ital heart defect: a) the Anderson sequential segmental analysis as modifie d according to the Berlin method; b) use of a special autoptic method corre sponding to the ultrasound findings, based on defining a preferred sectiona l plane; c) stereomicroscopically; or d) microscopically after embedding an d preparation of serial microscopic sections. For the pathologist the conse quence is that he has to adapt his autopsy method to the ultrasound finding s and the age of the fetus. This enables him to determine an optimal, case- based autopsy strategy for each type of cardiac defect, which is essential for monitoring of the prenatal diagnosis. The present paper discusses the v arious autoptic methods used in cases of congenital heart malformations and the consequences for the pathologist of the continuing improvements in pre natal diagnostics.