An approach to dissecting the congenitally malformed heart in the forensicautopsy - The value of sequential segmental analysis

The demonstration of congenital heart disease at autopsy necessitates the c areful preservation and examination of the heart, the vessels, and their co nnections. Techniques preserving these connections and using a reproducible and systematic approach are preferred. The Rokitansky method of organ bloc k dissection, in combination with a system of heart examination termed sequ ential segmental analysis, provides such an approach. This study is based o n the examination of heart specimens accessioned into the Frank E. Sherman, M.D., and Cora C. Lenox, M.D., Heart Museum (containing approximately 2400 specimens) of the Pathology Department, Children's Hospital of Pittsburgh. Specimens received in consultation during a 25-year period from hospitals and coroners'/medical examiners' offices were examined, and the correspondi ng reports were reviewed. Of 46 total heart specimens examined (1975-1999), 29 (63%) were dissected properly or left intact for dissection at Children 's Hospital of Pittsburgh, and 17 (37%) were incorrectly dissected for the demonstration of congenital heart disease. Of these 17 cases, 11 (24%) disp layed dissection errors, which did not hinder a complete diagnosis, 3 cases (6.5%) had errors that enabled only an incomplete diagnosis. and in 3 case s (6.5%), no diagnosis of congenital heart disease could be made. Dissectio n mistakes and means of avoiding them are discussed. Review of medical and family history, external and internal examination. and a reproducible and s equential method of examining the heart and its connections enables documen tation of even the most complex cardiovascular anomalies.