Postmortem imaging in congenital heart disease: preliminary experience

Abstract

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.

Purpose: 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.

Material and 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.

Conclusion: 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.

Keywords: Cardiac; computed tomography (CT) angiography; congenital heart disease; magnetic resonance imaging (MRI); pathology.