Postmortem imaging in congenital heart disease: preliminary experience.
BACKGROUND
Despite the importance of the autopsy for quality improvement, autopsy rates have declined dramatically in recent decades due to poor acceptance by families and physicians and high costs to institutions.


OBJECTIVE
To compare postmortem imaging (PMI) with autopsy in patients with congenital heart defects to see if PMI could substitute in some or all cases and to compare costs of the two methods.


METHODS
Ten patients with congenital heart disease dying in hospital during the study period in whom an autopsy was planned underwent PMI using postmortem magnetic resonance imaging (PMMRI) (6 patients) and postmortem computed tomographic angiography (PMCTA) (10 patients) with permission of the family. Four patients were excluded from PMMR because of metal ECMO cannulas. PMI was interpreted before autopsy using an organ system checklist and results compared to autopsy. The costs of each method were tracked.


RESULTS
When both PMMR and PMCTA were performed the PMI findings corresponded closely with autopsy. PMI correctly diagnosed the principal heart defects in all six cases and correctly imaged central vessels, heart valves and chambers, brain, abdominal organs, and bone. Weak points were visualization of the coronary arteries and distinguishing postmortem pulmonary atelectasis from lung pathology. The cause of death by PMI matched autopsy findings in 5/6 cases in which both PMMR and PMCTA were performed and was incomplete in the other five cases. The cost of PMI was about 15% lower than the cost of autopsy.


CONCLUSIONS
PMI provided most gross anatomic cardiac diagnoses available by autopsy in our series of patients with congenital heart defects and the cost appears to be lower.
Department of Pediatric Cardiology and Adult Patients with Congenital Heart Disease - IRCCS Policlinico San Donato, Milan, Italy Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Francesca Romana
FR
Pluchinotta
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Prashob
P
Porayette
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Abbas Haider
AH
Zaidi
Department of Pathology, Boston Children's Hospital, Boston, MA, USA.
John
J
Baci
Department of Pathology, Boston Children's Hospital, Boston, MA, USA.
Lisa
L
Teot
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA Department of Pathology, Boston Children's Hospital, Boston, MA, USA stephen.sanders@childrens.harvard.edu.
Stephen P
SP
Sanders
Department of Radiology, Boston Children's Hospital, Boston, MA, USA.
Sanjay P
SP
Prabhu
D000293:Adolescent; D000328:Adult; D001344:Autopsy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005554:Forensic Medicine / Q000379:methods*; D006330:Heart Defects, Congenital / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007223:Infant; D007231:Infant, Newborn; D007479:Iopamidol / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007479:Iopamidol
Cardiac; computed tomography (CT) angiography; congenital heart disease; magnetic resonance imaging (MRI); pathology