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The postoperative pathology of congenital heart disease

Published online by Cambridge University Press:  19 August 2008

Robert H. Anderson  and
Siew Yen Ho
Robert H. Anderson*
Affiliation:
From the Department of Paediatrics, National Heart & Lung Institute, London
Siew Yen Ho
Affiliation:
From the Department of Paediatrics, National Heart & Lung Institute, London
*
Correspondence to Dr. Robert H. Anderson, Department of Paediatrics, National Heart and Lung Institute, Dovehouse Street, London SW36LY, United Kingdom. Tel. 44-71-351-8940; Fax. 44-71-351-8230
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Abstract

The role of the pathologist is changing with regard to the assessment of postoperative congenital heart disease. Whereas, in the past, the access to autopsied hearts provided the opportunity for detailed description and classification, nosologic details of cardiac malformations are now largely agreed. While a detailed analysis of the lesion remains an integral part of the pathologist's task, future advances will now largely be dictated by careful analysis of the effects of cardiac surgery. Such analysis can be divided into early and late phases. When assessing the specimen from a death occurring in the operating room or in the immediate postoperative period, the pathologist must examine carefully the operative incisions, and the correctness of the surgical procedure. Proper assessment of the procedure will necessitate removal of patches and pathways constructed by the surgeon, having documented carefully the location of sutures used to secure the foreign materials. The autopsy must also include assessment of the organs in the rest of the body, particularly the lungs, and must not ignore the immediate effect of the operative procedure on myocardial status. In the late phase, while again assessing in detail the access to the heart and the procedures employed during surgical correction, the pathologist will take care to evaluate the long-term effects of the procedure on the valves of the heart, the myocardium, the pulmonary vasculature and the other organs. At this stage, care should also be taken to ensure that late scarring does not involve the conduction tissues. Particular care will be needed when assessing the efficacy and durability of prosthetic materials inserted into the heart. Most of these steps will be undertaken intuitively by the pathologist, but interest in cardiac pathology as a specialty seems to be waning. The clinician can combat this trend by ensuring that all cases dying after operative procedures are obtained for autopsy, and by encouraging the pathologist to become involved in this fascinating area.

Keywords

Cardiac pathologycongenital heart diseasecardiac surgery
Type
Review and Comment
Information
Cardiology in the Young , Volume 3 , Issue 2 , April 1993 , pp. 147 - 157
Copyright
Copyright © Cambridge University Press 1993

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References

1.Abbott, ME. Atlas of Congenital Cardiac Disease. The American Heart Association, New York, 1936.Google Scholar
2.Edwards, JE. Pathology of the Heart and Great Vessels. 3rd Edition. Charles C. Thomas, Springfield, Illinois, 1968, pp 262–478.Google Scholar
3.Dickinson, DF, Wilkinson, JL, Anderson, KR, Smith, A, Ho, SY, Anderson, RH. The cardiac conduction system in situs ambiguous. Circulation 1979; 59: 879–885.Google Scholar
4.Rossi, MB, Ho, SY, Anderson, RH, Kanter, K, Rigby, M, Lincoln, C. Morphological observations following “anatomical correction” for abnormal ventriculo-arterial connection. Thorac Cardiovasc Surgeon 1985; 33: 210–214.Google Scholar
5.Becker, AE, Anderson, RH. Pathology of Congenital Heart Disease. Butterworths, London, 1981.Google Scholar
6.Longenecker, CG, Reemtsma, K, Creech, O Jr. Anomalous coronary artery distribution associated with tetralogy of Fallot: A hazard in open cardiac repair. J Thorac Cardiovasc Surg 1961; 42: 258–262.Google Scholar
7.Meng, CC, Eckner, FAO, Lev, M. Coronary artery distribution in tetralogy of Fallot. Arch Surg 1965; 90: 363–396.Google Scholar
8.Anderson, KR, McGoon, DC, Lie, JT. Surgical significance of the coronary arterial anatomy in truncus arteriosus communis. Am J Cardiol 1978; 41: 76–81.Google Scholar
9.Allwork, SP, Bentall, HH, Becker, AE, Cameron, H, Gerlis, LM, Wilkinson, JL, Anderson, RH. Congenitally corrected transposition of the great arteries: morphologic study of 32 cases. Am J Cardiol 1976; 38: 910–923.Google Scholar
10.Anderson, RH, Becker, AE, Arnold, R, Wilkinson, JL. The conducting tissues in congenitally corrected transposition. Circulation 1974; 50: 911–923.Google Scholar
11.Cheung, HC, Lincoln, C, Anderson, RH, Ho, SY, Shinebourne, EA, Pallides, S, Rigby, ML. Options for surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis. J Thorac Cardiovasc Surg 1990; 100: 672–681.Google Scholar
12.Ho, SY, Fagg, N, Anderson, RH, Cook, A, Allan, L. Disposition of the atrioventricular conduction tissues in hearts with isomerism of the atrial appendages: its relationship to congenitally complete heart block. J Am Coll Cardiol 1992; 20: 904–910.Google Scholar
13.Thiene, G, Wenink, AC, Frescura, C, Wilkinson, JL, Gallucci, V, Ho, SY, Mazzucco, A, Anderson, RH. Surgical anatomy and pathology of the conduction tissues in atrioventricular defects. J Thorac Cardiovasc Surg 1981; 82: 928–937.Google Scholar
14.Pillai, R, Ho, SY, Anderson, RH, Shinebourne, EA, Lincoln, C. Malalignment of the interventricular septum with atrioventricular septal defect: its implications concerning conduction tissue disposition. Thorac Cardiovasc Surgeon 1984; 32: 1–3.Google Scholar
15.Till, JA, Ho, SY, Rowland, E. Histopathological findings in three children with His bundle tachycardia occurring subsequent to cardiac surgery. Eur Heart J 1992; 13: 709–712.Google Scholar
16.Thiene, G, Mazzucco, A, Anderson, RH, Faggian, G, Frescura, C, Bortolotti, U, Gallucci, V. Tetralogy of Fallot after surgery: autopsy review of 14 cases. Human Pathology 1984; 15: 1018–1024.Google Scholar
17.Hartung, HW, Rolfs, F, Klein, HH, de, Vivie ER. latrogenic transposition of vena cava inferior to the left atrium, a rare complication in surgical repair of atrial septum secundum defect. Thorac Cardiovasc Surgeon 1987; 35(Suppl I): I76–I77. [Abstract]Google Scholar
18.Hegerty, A, Anderson, RH, Deanfield, JE. Myocardial fibrosis in tetralogy of Fallot: effect of surgery or part of the natural history? Br Heart J 1988; 59: 123. [Abstract]Google Scholar
19.Kirklin, JW. Perspectives in Pediatric Cardiology, Volume 2. Pediatric Cardiac Surgery, Part 1. Futura Publishing Company Inc., Mount Kisco, New York, 1989, pp 3–20.Google Scholar
20.Haworth, SG. Paediatric Cardiology, Volume 1. Churchill Livingstone, Edinburgh, 1987, pp 123–158.Google Scholar
21.Rabinovitch, M, Haworth, SG, Castañeda, AR, Nadas, AS, Reid, LM. Lung biopsy in congenital heart disease: a morphometric approach to pulmonary vascular disease. Circulation 1978; 58: 1107–1122.Google Scholar
22.Glauser, TA, Rorke, LB, Weinberg, PM, Clancy, RR. Congenital brain anomalies associated with the hypoplastic left heart syndrome. Pediatr 1990; 85: 984–990.Google Scholar
23.Glauser, TA, Rorke, LB, Weinberg, PM, Clancy, RR. Acquired neuropathologic lesions associated with the hypoplastic left heart syndrome. Pediatr 1990; 85: 991–1000.Google Scholar
24.Smith, A, Ho, SY, Anderson, RH. Histological study of the cardiac conducting system as a routine procedure. Med Lab Sci 1977; 34: 223–229.Google Scholar
25.Penkoske, PA, Neches, WH, Anderson, RH, Zuberbuhler, JR. Further observations on the morphology of atrioventricular septal defects. J Thorac Cardiovasc Surg 1985; 90: 611–622. [published erratum appears in J Thorac Cardiovasc Surg 1988; 95: 146]Google Scholar
26.Anderson, RH, Zuberbuhler, JR, Penkoske, PA, Neches, WH. Of clefts, commissures, and things. J Thorac Cardiovasc Surg 1985; 90: 605–610.Google Scholar
27.Weintraub, RG, Brawn, WJ, Venables, AW, Mee, RBB. Two patch repair of complete atrioventricular septal defects in the first year of life. Results and sequential assessment of atrioventricular valve function. J Thorac Cardiovasc Surg 1990; 99: 320–326.Google Scholar
28.Capouya, ER, Laks, H, Drinkwater, DC Jr, Pearl, JM, Milgalter, E. Management of the left atrioventricular valve in the repair of complete atrioventricular septal defects. J Thorac Cardiovasc Surg 1992; 104: 196–203.Google Scholar
29.Lamberti, JJ. Discussion on Capouya et al. Management of the left atrioventricular valve in the repair of complete atrioventricular septal defects. J Thorac Cardiovasc Surg 1992; 104: 201–203.Google Scholar