Department of Cardiovascular Pathology Armed Forces Institute of Pathology Washington dc

This chapter is written with the forensic pathologist in mind as often he has to autopsy a large number of cases in a single day and therefore does not have the luxury of time. It is of utmost importance that the heart be examined carefully and methodically in order to obtain maximal information to establish the cause of death. The most common method of examination of the heart has been the opening of each of the four chambers according to the direction of the flow of blood.1,2

Briefly, the right atrium is opened from the inferior vena cave to the tip of the atrial appendage; the right ventricle is opened along its lateral border through the tricuspid valve and annulus to the apex of the right ventricle with extension to the pulmonary outflow tract close to the ventricular septum. The left atrium is opened by cutting across the roof of the atrium between the left and right pulmonary veins; and the left ventricle is opened laterally between the anterior and posterior papillary muscles to the apex and then cut along the anterior wall adjacent to the ventricular septum through the aortic outflow tract. The classic method is a logical approach for congenital heart disease, in which preservation of the landmarks is useful. However, it is not optimal for evaluation of myocardial infarction, acute or healed, and for infiltrative diseases and cardiomyopathies, because it does not readily allow for the assessment of ventricular cavity diameter and ventricular septal thickness. This chapter is especially directed towards the practice of forensic pathology, and outlines optimal methods for sectioning the heart in ischemic heart disease, valvular heart disease, and cardiomyopathy.

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