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The value of autopsy in pediatric cardiology and cardiovascular surgery
Chen-Chih J Sun1, Gladys Alonsonzana, Jon C Love
1Department of Pathology and Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Insights
Pediatric autopsies remain valuable for congenital heart disease (CHD) diagnosis and determining causes of death, even with advanced technology. These postmortem examinations offer crucial insights impacting patient management and revealing unexpected findings.
Area of Science:
- Pediatric Pathology
- Cardiovascular Medicine
- Medical Diagnostics
Background:
- The autopsy's role in verifying premorbid diagnoses is historically significant.
- Advancements in diagnostic imaging have prompted re-evaluation of the autopsy's utility.
- Congenital heart disease (CHD) management benefits from accurate diagnostic data.
Purpose of the Study:
- To evaluate the value of pediatric autopsies in the context of modern diagnostic and surgical advancements for CHD.
- To assess the impact of autopsy findings on clinical management strategies for pediatric CHD patients.
- To determine the accuracy of premorbid diagnoses and identify the cause of death through postmortem examination.
Main Methods:
- Comparison of pre-mortem clinical data with post-mortem autopsy findings in 29 children with CHD.
- Evaluation of the accuracy of cardiac anatomy diagnosis.
- Assessment of the confirmed cause of death and identification of additional abnormalities.
Main Results:
- Autopsy confirmed cardiac anatomy in 45% of cases.
- Additional cardiovascular abnormalities with clinical significance were identified in 38% of cases.
- The autopsy confirmed the cause of death in 52% of cases and identified it in an additional 41%.
Conclusions:
- Pediatric autopsies continue to yield clinically relevant information in children with CHD.
- Autopsies reveal unexpected causes of death in a substantial number of cases.
- Postmortem findings have a significant potential impact on patient management and clinical decision-making.
Abstract:
Autopsy has been considered extremely helpful in determining the accuracy of the premorbid diagnosis. With recent advances in diagnostic imaging, the value of the autopsy has been called into question. The aim of this study was to assess the value of the pediatric autopsy in the current era of advanced diagnostic technology and sophisticated surgical intervention for congenital heart disease (CHD) and also to determine the autopsy's potential impact on clinical management. We compared the data from the postmortem examination of 29 children with CHD with the data obtained before death and evaluated for the accuracy of the diagnosis of the cardiac anatomy as well as the cause of death. The diagnosis of the anatomy was confirmed in 13 cases (45%), additional cardiovascular abnormalities with potential clinical impact were found in 11 cases (38%), and additional abnormalities without clinical impact were found in 5 cases (17%). The cause of death was confirmed in 15 cases (52%), determined by autopsy in 12 cases (41%), and uncertain in 2 cases (7%). We conclude that the pediatric autopsy continues to provide clinically relevant information with a potential impact on patient management and to reveal unexpected causes of death in a significant proportion of patients with CHD.
