Diagnosis of congenital heart malformations - possibilities for the employment of telepathology

Goal: In a study of 10 autopsy cases with congenital cardiac malformations we investigated whether obtaining a second opinion by means of telepatholog y could satisfy quality standards for the diagnosis of cardiac malformation s and what the advantages and disadvantages of such a procedure might be. M aterial: The investigatory samples were 10 formalin-fixed hearts with compl ex malformations from 9 fetuses and one newborn on which autopsies had been performed at the Pathological Institute of the Charite Hospital. The reque sts for a second opinion, which included text and image data, were sent in the form of Microsoft PowerPoint presentations to 5 experts in 4 countries. Per case the number of images that were sent was between 3 and 7. The size of the files was between 439 and 942 kb. The time required for preparation of the cases for sending them to the specialists was between 1 and 2 hours : this encompassed the time for putting the notation on the images, compres sing them, creating a file that included both the images and the clinical d ata and then sending the case file. Results: All 10 cardiac malformations w ere correctly identified. In 8 of the 10 cases at least one expert had ques tions. After these questions had been answered and further images had been sent final correct diagnoses were made in all cases. All experts said that the quality of the images was very good. Use of a standardized findings que stionnaire, which also included the marking of anatomic structures and of p athological findings in the images, proved useful. Standardized findings fo rms facilitate orientation during interpretation of the cases and should be used generally to avoid misunderstandings in telepathological communicatio n. Conclusions: In general it is possible to obtain an effective and reliab le diagnosis of congenital heart malformations by means of telepathology. I t is far quicker to get a second opinion by this means than by conventional means.