Post-mortem computed tomography (PMCT) and PMCT-angiography after cardiac surgery. Possibilities and limits

Area of Science:

• Forensic Pathology
• Medical Imaging
• Cardiovascular Surgery

Background:

• Postmortem computed tomography (PMCT) is a globally utilized forensic tool.
• PMCT-angiography enhances diagnostic capabilities beyond standard PMCT.
• This study explores the utility of PMCT and PMCT-angiography in post-cardiac surgery cases.

Purpose of the Study:

• To demonstrate the capabilities of PMCT and PMCT-angiography in evaluating complications after cardiac surgery.
• To highlight the value of these imaging modalities in forensic pathology and surgical improvement.

Main Methods:

• Selection of exemplary cases with characteristic findings.
• Whole-body PMCT acquisition with specific parameters (1mm slice, 130kV, 16-slice MDCT).
• PMCT-angiography involving arterial, venous, and circulatory phase contrast injections.

Main Results:

• PMCT identified sternal fractures, pseudoarthrosis, TAVI encroachment on coronary ostia, bleeding, and tamponade.
• PMCT-angiography revealed bleeding sources, vascular stenosis/obstruction, and altered vascular supply.
• Postoperative complications like malpositioned tubes/drains and puncture complications were visualized.

Conclusions:

• PMCT and PMCT-angiography accurately visualize complications and determine causes of death post-cardiac surgery.
• Findings can inform strategies to prevent patient suffering and mortality.
• The data may contribute to refining valve design and surgical implantation techniques.