Postmortem Angiographic Findings Research Articles

Traumatic Rupture of the Middle Cerebral Artery Followed by Acute Basal Subarachnoid Hemorrhage: Tailored Approach in Forensic Pathology by Aid of Post-mortem Angiographic Findings

Traumatic Rupture of the Middle Cerebral Artery Followed by Acute Basal Subarachnoid Hemorrhage: Tailored Approach in Forensic Pathology by Aid of Post-mortem Angiographic Findings

Variation in the blood supply of the sinus node

The purpose of the study was to examine the anatomical variations in the blood supply to the sinus node. Gross anatomical examination and angiographic evaluation were performed in 400 human hearts derived from victims of various accidents. The sinus node artery was a branch of the right coronary artery in 245 cases, the left circumflex in 147 cases, and both coronary arteries in 8 cases. In one subject, two sinus node arteries were found to arise from the left circumflex artery, a finding never reported before. Anatomic and postmortem angiographic findings of a previously unreported case where the sinus node is perfused by two sinus node arteries originating from the left circumflex coronary artery are demonstrated. Knowledge of this anatomical variation is useful for anatomists and of clinical significance for the interventional cardiologists and mainly for the cardiac surgeons in planning the surgical procedures.

Ectopic “high” origin of both coronary arteries from the left aortic wall: Anatomic and postmortem angiographic findings

Ectopic “high” origin of both coronary arteries from the left aortic wall: Anatomic and postmortem angiographic findings

Variant of the left coronary artery with an unusual origin and course: anatomic and postmortem angiographic findings.

This study demonstrates anatomic and postmortem angiographic findings characterizing the origin of the left coronary (LC) artery arising in common trunk with the right coronary (RC) artery from the right aortic sinus and its course via the ventricular septum (VS) to the left heart. This anomaly was a single finding observed among 388 angiographies and 60 corrosion castings. The course of the LC was divided in four segments. The first three form a curve that is upward concave. Large branches to the septomarginal trabecula (ST), VS, diagonals (DS), and the small anterior interventricular (anterior descending) artery originated from the outer part of this curve. In the anteroposterior x-ray, the above curve resembles a deep-bottom pot with a handle corresponding to the fourth segment. In the right anterior oblique, the first and second segments form a large erect angle. The third segment occupies the lower part of the absent proximal anterior interventricular artery, and the fourth crosses the outflow tract and the first segment in the middle. The course of these four segments of LC resembles the shape of the number 6. These findings are important for interpreting coronary angiographies in patients with this anomaly.

Postmortem Angiographic Findings for Arteries Supplying the Lumbar Spine

We evaluated 56 postmortem lumbar aortograms to study differences between subjects with and without low-back pain in the lumbar and middle sacral arteries. Twenty-two of 25 (88%) cases with back pain history had one or more missing arteries, 20 (80%) of them had narrow arteries, and 18 (72%) had developed collaterals. The corresponding figures for 22 age-matched controls were 13 (59%), 12 (55%), and 12 (55%), and for nine young (i.e., age ≤ 30 years) controls two (22%), two (22%), and two (22%). The cases had on average 2.04 entirely missing and 1.32 narrow (≤50% in diameter) arteries, compared with the age-matched controls who had 0.82 missing (p<0.001 for difference from cases) and 0.59 narrow arteries (p<0.01). We conclude that insufficient arterial blood flow may be an underlying factor for low-back symptoms. Atheromatous lesions in the abdominal aorta or congenital hypoplasia of the arteries may explain the angiographic findings.

Postmortem Angiographic Findings for Arteries Supplying the Lumbar Spine

We evaluated 56 postmortem lumbar aortograms to study differences between subjects with and without low-back pain in the lumbar and middle sacral arteries. Twenty-two of 25 (88%) cases with back pain history had one or more missing arteries, 20 (80%) of them had narrow arteries, and 18 (72%) had developed collaterals. The corresponding figures for 22 age-matched controls were 13 (59%), 12 (55%), and 12 (55%), and for nine young (i.e., age < or = 30 years) controls two (22%), two (22%), and two (22%). The cases had on average 2.04 entirely missing and 1.32 narrow (< or = 50% in diameter) arteries, compared with the age-matched controls who had 0.82 missing (p < 0.001 for difference from cases) and 0.59 narrow arteries (p < 0.01). We conclude that insufficient arterial blood flow may be an underlying factor for low-back symptoms. Atheromatous lesions in the abdominal aorta or congenital hypoplasia of the arteries may explain the angiographic findings.

Pathologic changes in aortocoronary saphenous vein grafts

Aortocoronary saphenous vein grafts from 40 patients (total 62 grafts) were studied at autopsy. The earliest change seen was the insudation of blood constituents into the vein intima. Occluding thrombi were seen in six grafts from short-term survivors, and one organized thrombus was seen in a graft from a long-term survivor (28 months). Various degrees of intimai thickening were seen in grafts from all patients surviving for more than a month; this had progressed to diffuse occlusion in three cases. Gross and microscopic findings correlated well with postmortem angiographic findings in the long-term survivors. Electron microscopic examination showed smooth muscle cells, collagen fibers and ground substance in the thickened intima. Fibroblasts were not a feature of this thickening. Increased permeability of the graft endothelium, due to injury or hemodynamic factors, may result in exposure of medial smooth muscle cells to certain plasma factors and thus promote smooth muscle cell hyperplasia as has been produced in certain experimental models.

A Technic of Postmortem Angiography for Evaluating Arteriosclerosis of the Aortic Arch and Carotid and Vertebral Arteries

With the increasing application of carotid and vertebral angiography in defining the stroke syndrome, there has been a greater need for correlation of the atheromatous lesions observed radiographically with those found at autopsy. Although studies of the gross and microscopic anatomy of stenotic lesions involving these vessels are plentiful, there have been few reports describing the postmortem angiographic findings (1). The usual method of injecting a semi-solid or solidifying radiopaque medium into the vessels to be examined is objectionable (1, 2) from the point of view of satisfactory embalming of the face, if not an actual deterrent, and makes impossible proper evaluation of the arteries and the brain by the pathologist. It was necessary, therefore, to devise a technic by which the contrast medium would temporarily distend the injected vessels and then dissipate rapidly. The criteria for this study will subsequently be outlined. Material and Technics One hundred and thirty postmortem examinations were performed. The angiographic technics were designed to satisfy the following requirements: (a) to allow optimum evaluation of stenotic lesions occurring in the branches of the aortic arch and the carotid and vertebral arterial systems; (b) not to interfere appreciably with the performance of the postmortem examination; (c) not to interfere with the embalming procedure. The prosector begins the postmortem examination in the usual fashion, except that the removal of the brain is post- poned until the end of the procedure. A high neck flap is reflected from the “Y” skin incision. While the bowel is being removed and appropriate cultures are being obtained, the great vessels of the aortic arch are dissected free of their investing tissues. The subclavian arteries are followed distal to the scalenus anticus muscle; the vertebral arteries, thyrocervical trunk, costocervical trunk, and internal mammary arteries are identified and freed of their investing tissues. Ligatures of silk are placed about the distal subclavian and the other aforementioned arteries with the exception of the vertebral arteries. The aorta is then cut above the aortic valve and about 6 to 8 cm. distal to the arch (Fig. 1). The body is then eviscerated by cutting the trachea and the esophagus below the clavicles and leaving the neck organs in situ (after the method of Rokitansky). Two plastic catheters (Fr. #14 or #12, depending on the size of the vessels), with a circle of adhesive near the end to prevent withdrawal, are threaded into the carotid arteries, being held in place by the atraumatic application of umbilical tape (Fig. 2). Two liters of saline are perfused through these vessels at approximately systolic pressure to remove clotted blood. The two catheters are then placed in the subclavian arteries in a similar fashion and perfusion of the vertebral arteries is accomplished.