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Updated: Jul 15, 2026
A Simplified Model for Heterotopic Heart Valve Transplantation in Rodents
Published on: September 21, 2021
Review of pathologic findings in remnant hearts following valve donation
Shannon Mackey-Bojack1, Susan Roe, Jack L Titus
1Jesse E. Edwards Registry of Cardiovascular Disease, 333 North Smith Avenue, Room 4625, St. Paul, MN 55102, USA. shannon.mackey-bojack@allina.com
Insights
Heart valve donation by medical examiners/coroners (ME/C) is feasible, as cardiovascular pathologic examination of heart remnants does not impede cause of death determination. This study found significant cardiac abnormalities and inheritable conditions, highlighting the benefits of post-donation examination.
Area of Science:
- Cardiovascular Pathology
- Forensic Pathology
- Organ Donation
Background:
- Medical examiners/coroners (ME/C) often prevent heart valve donation, impacting tissue procurement agencies.
- ME/Cs are responsible for determining cause and manner of death, which can conflict with donation processes.
- The Jesse E. Edwards Registry of Cardiovascular Disease partnered with the American Red Cross (ARC) for post-donation cardiovascular pathology examinations.
Purpose of the Study:
- To review cardiovascular abnormalities in heart remnants after valve donation.
- To determine if heart valve donation interferes with the determination of cause of death.
- To identify significant, incidental, and inheritable cardiac conditions.
Main Methods:
- Retrospective review of 593 post-valve recovery heart remnants from October 2001 to January 2005.
- Cases were divided into natural and non-natural manner of death groups based on preliminary cause of death provided by ARC.
- Cardiac findings, including significant conditions, incidental findings, and congenital abnormalities, were tabulated.
Main Results:
- Of 593 cases, 106 were natural and 487 were non-natural manner of death.
- In the natural group, 91 cases had suspected cardiac causes of death with 132 significant cardiac findings.
- In the non-natural group, 214 significant cardiac findings were identified. Atherosclerotic coronary artery disease was the most common abnormality in both groups. Potentially inheritable conditions like hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy were identified.
Conclusions:
- Heart valve donation does not severely impair cardiac pathologic examination.
- Cardiovascular pathologic examination by a cardiac pathologist identifies significant and incidental findings.
- This process also aids in recognizing potentially inheritable cardiovascular conditions.
Abstract:
The failure of medical examiners/coroners (ME/C) to allow heart valve donation is a major problem encountered by tissue agencies. Even though many ME/C favor tissue donation they remain responsible for determination of cause and manner of death. In 2001, the Jesse E. Edwards Registry of Cardiovascular Disease was approached by one of the nation's largest tissue procurement agencies (The American Red Cross--ARC) for the purpose of performing cardiovascular pathologic examinations following valve donation. The affiliation existed from October 2001 to January 2005. This study was undertaken to review all 593 postvalve recovery heart remnants received during that time period to tabulate the abnormalities identified and to determine whether donation interfered with the determination of cause of death. For each case, a preliminary cause of death was provided by the ARC. The decedent's body height and weight were also provided. Using the preliminary cause of death, the 593 cases were divided into natural and nonnatural manner of death groups. This division of the cases resulted in 106 cases placed in the natural manner of death group and 487 cases in the nonnatural manner of death group. For each case, all cardiac findings including significant conditions, additional findings, incidental findings, and congenital abnormalities were tabulated. Within the natural manner of death group, 15 cases had a noncardiac cause of death and 91 cases had a cause of death suspected to be cardiac related. In the 91 cases, a total of 132 significant cardiac findings were identified and there were six structurally normal hearts including two infants. In the nonnatural manner of death group, 214 significant cardiac findings were identified and 222 cases had a structurally normal heart. In both natural and nonnatural groups, the most common cardiac abnormality was atherosclerotic coronary artery disease. Other frequently encountered conditions were also identified including 11 cases with acute angle of origin of a coronary artery (five cases natural group; six cases nonnatural group). An important feature of this review was the recognition of potentially inheritable conditions that were diagnosed in both natural and nonnatural manner of death groups. There were three cases of hypertrophic cardiomyopathy (one natural; two nonnatural), three cases of arrhythmogenic right ventricular cardiomyopathy (one natural; two nonnatural), and one case of mitral valve prolapse (natural). In reviewing these cases, we did not feel that valve donation severely impaired cardiac pathologic examination. The benefits of cardiovascular pathologic examination by a cardiac pathologist include the identification of significant and incidental findings and recognition of potentially inheritable conditions.
