A Simplified Technique for Postmortem Evaluation of Coronary Arteries

The growth of complex diagnostic and therapeutic technologies in the clinical management of cardiovascular diseases has mandated a more comprehensive and detailed analysis of cases which reach the pathology laboratory. This report describes in detail the relatively simple techniques and protocol which we have employed for postmortem evaluation of the coronary vascular bed and myocardium. The key elements include the use of a pigmented gelatin mass containing radiopaque material (Barosperse), proper injection technique with simultaneous filling of the main coronary vessels at identical pressures, postmortem arteriography, cardiac dissection, and histologic confirmation of coronary and myocardial lesions. Three cases with sharply differing cardiac diseases are presented to illustrate the kind of information which may be obtained with this approach. Our experience in terms of frequency and distribution of occlusive coronary vascular disease and the relationship to age and sex has been summarized. Significant disease (> 75% lumenal obstruction) was identified angiographically and confirmed by dissection in 46 of 57 cases of clinically suspected disease. None of six hearts from patients without clinical evidence for cardiovascular disease demonstrated actual or angiographically false-positive occlusive coronary disease. It is suggested that a more detailed analysis of the coronary vascular bed can be accomplished in the pathology laboratory with this relatively simple approach and that important information bearing on clinical management can be reliably obtained.