Gross Dissection of Heart

8/10/2019 Gross Dissection of Heart

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Evaluation of External Cardiac and GreatVessel Morphology

Dissection of Coronary Arteries

Dissection of Heart Dissection of Cardiac Conduction System







Examineepicardium◦ Pericarditis

◦ “Soldier’s patches” “Milk spots”

◦ Petechiae

◦ Trauma

http://www.wikidoc.org/images/5/5b/Petechiae_heart_001.jpg

http://www.wikidoc.org/images/7/72/Soldiers_Patch_1.jpg



Atrial-ventricularconcordance

Relative proportion

of right and leftventricles



Anatomy Origins



Anatomy◦ Right dominant

◦ Left dominant

◦ Balanced dominance



Anatomy Origins

Dissection◦

Transversesectioning 0.3 cmapart

◦ Estimation of luminalstenosis



Anatomy Origins Dissection

◦ Decalcification Not typically performed Dissect origin of

coronary artery alongwith button of aorta

Fix LCA and RCA with

their respectivebranches

Decalcify andsubsequently section



Lines of Flow◦ Typically reserved for

pediatric hearts

◦ Utilize Mayo scissors



◦ IVC R atrialappendage Assess patency of

foramen ovale

Assess tricuspid valve

◦ IVC – posterior RVadjacent to septum RV apex

◦ RV apex – anterior RVadjacent to septum Pulmonary artery Assess RV thickness ~

1cm distal to TV



◦ Connect R pulmonaryvein and L pulmonaryvein orifices Assess mitral valve

◦ R pulmonary vein – posterior LV adjacentto septum LV apex

◦ LV apex – anterior LV– serpiginous cut to

avoid pulmonaryartery aorta Assess LV thickness ~

1cm distal to MV



Lines of Flow◦ Typically reserved for

pediatric hearts

◦ Utilize Mayo scissors

Transversesectioning◦ Aka “breadloafing”

◦ Utilize knife



Anterior toposterior slicesstarting at apex◦ ~ 1cm in thickness

◦ Stop ~ 1cm distal toAV valves

The atria andremaining portion

of ventricles aredissected by linesof flow



Remove anyresidual atrial andventricular clot

Section aorta andpulmonary artery ~1cm distal to valves



Examine for◦ Antemortem

thrombus◦ Subendocardial

fibrosis◦ Cusp/leaflet

morphology◦ Ventricular

dilatation◦ Ventricular

hypertrophy◦ Acute / remote

infarction◦ Myocarditis

http://upload.wikimedia.org/wikipedia/commons/1/1e/Idiopathic_cardiomyopathy,_gross_pathology_20G0018_lores.jpg



Preparation◦ Gently pack atria with

cheesecloth

◦ Fix overnight in 20%

formalin



SA Node◦ 1st cut – Anterior to

crista terminalisthrough pectinatemuscles

◦ 2nd cut - Along upperborder of atrium intoSVC

◦ 3rd cut – SVC to IVCalong right atrial

septum◦ 4th cut – complete the

rectangle



SA Node◦ Section along the

long axis to produce6 – 8 sections

◦ Look for sinus nodeartery

◦ Ask for trichrome

stain

Ages 10 – 90 yrs % ofcollagen expectedwithin node is ~ equalto age



AV Node◦ Remove rectangle of

tissue containingTriangle of Koch

◦ Section along longaxis to produce 6 – 10 sections Label AV1 – AV#,

coronary sinus ventricular septum

◦ Ask for trichrome

stain





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Gross Dissection of Heart