Autopsy in the era of advanced cardiovascular imaging

Abstract

Historically, autopsy contributed to our current knowledge of cardiovascular anatomy, physiology, and pathology. Major advances in the understanding of cardiovascular diseases, including atherosclerosis and coronary artery disease, congenital heart diseases, and cardiomyopathies, were possible through autopsy investigations and clinicopathological correlations. In this review, the importance of performing clinical autopsies in people dying from cardiovascular disease, even in the era of advanced cardiovascular imaging is addressed. Autopsies are most helpful in the setting of sudden unexpected deaths, particularly when advanced cardiovascular imaging has not been performed. In this setting, the autopsy is often the only chance to make the correct diagnosis. In previously symptomatic patients who had undergone advanced cardiovascular imaging, autopsies still play many roles. Post-mortem examinations are important for furthering the understanding of key issues related to the underlying diseases. Autopsy can help to increase the knowledge of the sensitivity and specificity of advanced cardiovascular imaging modalities. Autopsies are particularly important to gain insights into both the natural history of cardiovascular diseases as well as less common presentations and therapeutic complications. Finally, autopsies are a key tool to quickly understand the cardiac pathology of new disorders, as emphasized during the recent coronavirus disease 2019 pandemic.

Autopsy of all young sudden death cases is important to increase survival in family members left behind

“…Over recent decades, however, there has been a decrease in autopsy rates in many countries across the globe ( Figure 3 ). 47 , 91 , 94 In general, increasing age and comorbidity burden are associated with lower rates of post-mortem examination, including both medicolegal external examination and autopsy. 15 , 22 , 47 , 95 , 96 This is problematic as it is well known that several comorbidities such as diabetes mellitus, kidney disease, and epilepsy are associated with higher risk of SD.…”

Anatomy across centuries: From ancient Greeks to modern innovations. The merit and significance of autopsies today

“…In the era of transcatheter aortic valve implantation (TAVI), a multi-center autopsy series of patients dying after the procedure showed that in the acute postimplantation time frame, the procedure could be associated with aortic annular rupture and thromboembolic ischemic stroke. In particular, bulky calcification in the left ventricular outflow tract under the left-coronary aortic cusp could be a risk factor for rupture during TAVI (46). Autopsies have also helped to demonstrate that the depth of prosthesis implantation is one of the most important predictors of the need for pacemaker implantation due to conduction disorders soon after transcatheter selfexpandable aortic valve implantation (47).…”

Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design

“…Autopsies are valuable for elucidating the pathophysiologic mechanisms of novel and poorly understood diseases by enabling deep phenotyping of tissues throughout the body [ 5 ]. Autopsies played a critical role in understanding the pathologic changes in patients dying from acute COVID-19.…”