[Macroscopic and microscopic heart preparation in ischemic heart diseases]

The quality of the morphological analysis of myocardial and coronary alterations depends essentially on the method chosen for the heart dissection. Even if previous postmortem coronary angioplasty is not feasible, the best results are obtained by transverse sectioning of the ventricles in a bread-loaf fashion subsequent to formalin-fixation and serial cross-sectioning of the coronary arteries, with decalcification in addition if necessary. The distribution pattern of disseminated myocardial necrosis, the longitudinal, circumferential and transmural extent of infarction, its age and sequelae and its correlation to the coronary supplying areas can be evaluated with better accuracy than by dissecting the heart chambers according to the flow of blood. Cross-sectioning of coronary arteries with preservation of their luminal shape allows proper examination of the degree and extent of luminal narrowing, plaque hemorrhage, parietal and occluding thrombi and the effects and complications of angioplastic procedures or bypass surgery. Transverse sectioning of the heart is a prerequisite for adequate examination following sudden cardiac death and short-term territorial ischemia. Full-thickness samples of the ventricular walls, taken systematically with respect to coronary narrowing and coronary supplying areas, enable identification of early myocardial damage.