Houser The Operated Heart at Autopsy

1. Auflage 2009
ISBN: 978-1-60327-808-9
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 238 Seiten

After 17 years of private practice as a cardiovascular surgeon, my partners qu- tionedtherationalityofmydecisiontoleavetheclinicalpracticebehindandbecome acardiovascular pathologist. Infact,theirdisbeliefofmyintentiontomakethe'leap of faith' was understandable. For a surgeon, the operating room is where the action is. It is as simple as that. And when a cardiac surgeon can hold in his hand a beating heart, now off-bypass and improved by an operation just completed, satisfaction is real and profound. However, life is complex. Throughout my surgical career, questions regarding the pathogenesis of atherosclerotic cardiovascular disease arose; curiosities of va- ous phenotypes of the disease piqued my interest. I became aware of the power of investigative techniques that might address these questions. I then began to realize that my career in the operating room left me little time to address them. I needed to study the disease full time in order to contribute to my understanding of it. Ironically, my ?rst autopsy as a pathology resident was on an individual with a past history of coronary artery bypass surgery. When it came to examining the heart, the dissection, as all pathologists know, was complex. However, I found it to be straightforward and enjoyable. But I subsequently learned that my fellow re- dents and mentors did not share my intrigue and comfort in de?ning the nuances of the operated heart.

Autoren/Hrsg.

Houser, Stuart Lair

Inhaltsverzeichnis

1; Preface;5
2; Acknowledgment;7
3;1 External Evidence of Open-Heart Surgery;14
3.1; Look at the Skin of the Chest Wall;15
3.2; Look at the Skin of the Extremities;16
3.3; Look for Tubes, Wires, and Lines in the Early Postoperative Period;17
3.4; Look for Evidence of Preterminal Mechical Ventricular Support;18
3.5; Look for Evidence of Acute Renal Failure;19
3.6; Miscellaneous External Findings Are Notable;19
3.7;References;20
4;2 Exposing the Cardiopulmonary Block;22
4.1; Adhesions Happen;22
4.2; The Chest Plate Has Information;23
4.3; Assist Devices Are Meaningful;25
4.4; Isolate the Heart with Care;25
4.5; Assess the Need for Coronary Artery Injection;27
4.6; Prepare the Aorta for Coronary Artery Injection;28
4.7; Preliminary Injection Is Instructive;29
4.8;References;32
5;3 The Postmortem Coronary Injection;33
5.1; Remember the Scout Film;33
5.2; Follow the Injection Protocol;34
5.3; Understand the Injection Protocol;37
5.4; A Story in Print Has Value;39
5.5;References;41
6;4 The Cardiac Dissection;42
6.1; The Parietal Pericardium May Be Socked In;43
6.2; Look at the External Surface of the Heart and Great Vessels;46
6.3; Take the Coronary Arteries Off the Heart;51
6.4; Stain with Tetrazolium;52
6.5; Open the Heart;53
6.5.1; Right Atrium;53
6.5.2; Right Ventricle;54
6.5.3; Left Atrium;54
6.5.4; Left Ventricle;55
6.5.5; Aortic Valve;58
6.5.6; Routine Measurements;61
6.6;References;61
7;5 Putting It All Together;63
7.1; Case 1: Nonpulsatile Blood Flow and the Gastrointestinal Tract;64
7.1.1; History;64
7.1.2; Procedure;64
7.1.3; Hospital Course;64
7.1.4; Autopsy Findings;64
7.1.5; Comment;65
7.1.6; Conclusions;65
7.2; Case 2: Hazard of a Re-Do Sternotomy;66
7.2.1; History;66
7.2.2; Procedure;66
7.2.3; Hospital Course;66
7.2.4; Autopsy Findings;67
7.2.5; Comments;67
7.2.6; Conclusions;68
7.3; Case 3: Cardiopulmonary Bypass in a Salvage Mode;68
7.3.1; History;68
7.3.2; Procedure;69
7.3.3; Hospital Course;69
7.3.4; Autopsy Findings;69
7.3.5; Comments;70
7.3.6; Conclusions;71
7.4; Case 4: A Problem of Heart Failure and Hardware;71
7.4.1; History;71
7.4.2; Procedure;72
7.4.3; Hospital Course;72
7.4.4; Autopsy Findings;72
7.4.5; Comments;72
7.4.6; Conclusions;73
7.5; Case 5: Prosthetic Valve Endocarditis;73
7.5.1; History;74
7.5.2; Procedure;74
7.5.3; Hospital Course;74
7.5.4; Autopsy Findings;74
7.5.5; Comments;75
7.5.6; Conclusions;75
7.6; Case 6: Aortic Root Reconstruction, Old Age, and Comorbidity;76
7.6.1; History;76
7.6.2; Procedure;76
7.6.3; Hospital Course;77
7.6.4; Autopsy Findings;77
7.6.5; Comments;78
7.6.6; Conclusions;79
7.7; Case 7: Pathology of Off-Pump Coronary Artery Bypass Surgery;79
7.7.1; History;79
7.7.2; Procedure;79
7.7.3; Hospital Course;80
7.7.4; Autopsy Findings;80
7.7.5; Comments;81
7.7.6; Conclusions;82
7.8; Case 8: Repair of Acute Aortic DissectionMaking Sense of the Findings;82
7.8.1; History;82
7.8.2; Procedure;83
7.8.3; Hospital Course;83
7.8.4; Autopsy Findings;83
7.8.5; Comments;84
7.8.6; Conclusions;85
7.9; Case 9: Technical Issues of Coronary Artery Bypass Surgery;85
7.9.1; History;85
7.9.2; Procedure;86
7.9.3; Hospital Course;86
7.9.4; Autopsy Findings;87
7.9.5; Comments;87
7.9.6; Conclusions;89
7.10; Case 10: Aortic Root Abscess and Postoperative Gastrointestinal Complications;90
7.10.1; History;90
7.10.2; Procedure;91
7.10.3; Hospital Course;91
7.10.4; Autopsy Findings;91
7.10.5; Comments;91
7.10.6; Conclusions;92
7.11; Case 11: Mitral Valve Plus Coronary Bypass Surgery on an Obese Diabetic;93
7.11.1; History;93
7.11.2; Procedure;93
7.11.3; Hospital Course;94
7.11.4; Autopsy Findings;94
7.11.5; Comments;94
7.11.6; Conclusions;95
7.12; Case 12: An Extraanatomic Approach to Treatment of Aortic Stenosis;97
7.12.1; History;97
7.12.2; Procedure;97
7.12.3; Hospital Course;97
7.12.4; Autopsy Findings;97
7.12.5; Comments;98
7.12.6; Conclusions;99
7.13; Case 13: An Acute Aortic Dissection Involving the Left Main Coronary Artery;100
7.13.1; History;100
7.13.2; Procedure;100
7.13.3; Hospital Course;100
7.13.4; Autopsy Findings;100
7.13.5; Comments;101
7.13.6; Conclusions;102
7.14; Case 14: ECMO Following Treatment of Congenital Heart Disease;103
7.14.1; History;103
7.14.2; Procedure;104
7.14.3; Hospital Course;104
7.14.4; Autopsy Findings;104
7.14.5; Comments;105
7.14.6; Conclusions;106
7.15; Case 15: Assessing Placement of a Biventricular Assist Device;107
7.15.1; History;107
7.15.2; Procedure;107
7.15.3; Hospital Course;107
7.15.4; Autopsy Findings;108
7.15.5; Comments;108
7.15.6; Conclusions;109
7.16; Case 16: Cardiac Surgery Through the Right Chest;110
7.16.1; History;110
7.16.2; Procedure;111
7.16.3; Hospital Course;111
7.16.4; Autopsy Findings;111
7.16.5; Comments;112
7.16.6; Conclusions;113
7.17; Case 17: ECMO One Day After Cardiac Surgery Through the Left Chest;114
7.17.1; History;114
7.17.2; Procedure;114
7.17.3; Hospital Course;114
7.17.4; Autopsy Findings;115
7.17.5; Comments;115
7.17.6; Conclusions;116
7.18; Case 18: Aortic Valve Replacement and Failure Coming Off Pump;117
7.18.1; History;117
7.18.2; Procedure;117
7.18.3; Hospital Course;117
7.18.4; Autopsy Findings;117
7.18.5; Comments;118
7.18.6; Conclusions;119
7.19; Case 19: Postoperative Complex Congenital Heart Disease at Autopsy;120
7.19.1; History;120
7.19.2; Procedure;120
7.19.3; Hospital Course;120
7.19.4; Autopsy Findings;121
7.19.5; Comments;121
7.19.6; Conclusions;122
7.20; Case 20: Right Ventricular Failure Following Transplantation;123
7.20.1; History;123
7.20.2; Procedure;123
7.20.3; Hospital Course;123
7.20.4; Autopsy Findings;124
7.20.5; Comments;124
7.20.6; Conclusions;125
7.21;References;126
8;6 Congenital Heart Disease and Surgical Footprints;133
8.1; Epsteins Anomaly;134
8.2; Single Ventricle;137
8.3; Double Outlet Right Ventricle;141
8.4; AV Canal Defect;142
8.5; Ventricular Septal Defect;143
8.6; Tetralogy of Fallot;146
8.7; Patent Foramen Ovale;151
8.8; Coronary Artery Anomaly;154
8.9; Bicuspid vs. Unicuspid Aortic Valve;157
8.10; Atrial Septal Defect;158
8.11; Patent Ductus Arteriosus;159
8.12; Transposition of the Great Vessels;161
8.13; Aortic Coarctation;162
8.14; Sinus of Valsalva Aneurysm;166
8.15; Endomyocardial Fibrosis;168
8.16;References;170
9;7 A Matter of Mindset;174
9.1; Exposure;174
9.2; Understanding;176
9.3; Interpretation;179
10;References;179
11;Abbreviations;179
11.1; Abbreviations;182
12;Glossary;179