title: Post-mortem computed tomography (PMCT) and PMCT-angiography after cardiac surgery. Possibilities and limits.
abstract: BACKGROUND
  PMCT is a well-known tool of the forensic pathologist. It is employed worldwide. PMCT-angiography offers additional insights. This paper intends to demonstrate possibilities of both methods after cardiac surgery.
  
  
  METHODS
  Exemplary cases with typical findings were selected from our own collection. PMCT was performed as whole body CT (1mm slice, pitch 1.5, 130kV, 180-130mAs, 16 slice MDCT). In PMCT-angiography, contrast material (1.2 litres) is injected into the arteries (arterial phase, also documented with a whole body CT). Thereafter, contrast material is injected into the veins (venous phase, also documented with a whole body CT). The final CT is obtained after circulation has been provoked with a special pump (circulatory phase).
  
  
  RESULTS
  PMCT visualised pseudoarthrosis and fractures of the sternum, implanted valves (TAVI) encroaching the ostia of the coronary arteries, bleeding and pericardial tamponade. PMCT-angiography showed the sources of the bleeding, vascular stenosis and obstruction and modified vascular supply. With respect to the postoperative care, malposition of tubes, drainages and complication of punctures could be seen.
  
  
  CONCLUSIONS
  PMCT and PMCT-angiography can visualise complications and the cause of death. Such knowledge may allow for prevention of suffering and death. It may also aid in improving valve design and implantation procedures.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Vogel
authors.forename: Axel
authors.initials: A
authors.lastname: Heinemann
authors.forename: Antonios
authors.initials: A
authors.lastname: Tzikas
authors.forename: Canasorn
authors.initials: C
authors.lastname: Poodendaen
authors.forename: Helmut
authors.initials: H
authors.lastname: Gulbins
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
authors.forename: Hermann
authors.initials: H
authors.lastname: Vogel
mesh_terms: D001344:Autopsy / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002423:Cause of Death; D017023:Coronary Angiography / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D049429:Forensic Pathology / Q000379:methods; D005858:Germany; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D011180:Postmortem Changes; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D011542:Pseudarthrosis / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*