Standardy postępowania w diagnostyce patomorfologicznej nagłego zgonu sercowego
Sudden cardiac death is one of leading causes of death in developed countries. In case of adults over 35 years the main cause of death ischaemic cardiac disease which results from coronary atheromatosis, whereas in children and young adults congenital heart defects and cardiomyopathies, but there are also many other possible causes. The knowledge about authentic reasons of sudden cardiac death is the first step to more effective control by proper therapy and prophylaxis.
The work presents different methods of heart autopsy with particular consideration for the new protocol which is recommended by the Association for European Cardiovascular Pathology (AECVP). The new recommendations are concerned with making multiple transverse cuts along the course of the main coronary arteries as well as through the heart muscle and also with taking a greater amount of samples from particular areas of the muscle. The new protocol was confronted with the tradidional procedure. Both methods were compared on the basis of initial authors` own experiences and the review of the literature.
Investigated patients between 50 and 82 years old, all died suddenly for cardiac reasons according to clinical information during the first 36 hours after admission to hospital. There was chronic ischaemic heart disease in anamnesis in 22 patients out of 30 in group A (autopsied according to the new standards), and in 6 out of 12 in group B (autopsied according to the traditional procedure). No patient had been treated by cardiosurgery before.
The presented analysis concentrates on aspects of gross examination of myocardium and heart vessels. Then both procedures, the traditonal one and the new one, are compared in relation to the time of duration, technical difficulties and diagnostic value.
Critical stenosis of the coronary artery (grade III) was assesed significantly more frequently in the first group (A) (6/30) than in the second group (B) (1/12). The existence of a recent thrombus occluding the lumen of the coronary artery was also confirmed more frequently in group A (12/30) than in group B (2/12). The new autopsy method of heart and coronary vessels turned out to have more diagnostic value. There were no gross or microscopic changes in the myocardium in group A in 4 out of 30 cases in comparison to 3 such cases out of 12 in group B.
From the authors`own experience it comes out, that the new autopsy procedure is more time consuming; it lasts on average 30 minutes longer. It is caused mainly by certain technical difficulties. What is more, the new standard is connected with a greater financial cost which is caused by a greater amount of samples taken for histopathological examination.
The results of our own studies confirm the reports from the literature. They speak for the new standards which allow making a better, more valuable and more accurate final diagnosis.