Damage to the head and neck of infants at autopsy.
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Autopsy↗
Biomedical subjects
W A Devine
Publications and source records attributed to W A Devine.
Anomalies of the left atrioventricular valve and related ventricular septal morphology in atrioventricular septal defects.
A characteristic feature of atrioventricular septal defects is a deficiency of the inlet part of the ventricular septum that results in a "scooped out" appearance. The depth of the scoop in relation to the disposition of the atrioventricular valves has been debated. To clarify the relation between the morphology of the ventricular septum and the disposition of the atrioventricular valves, we quantified these anatomic features in 151 hearts at autopsy to determine whether those features identified particular groups within the overall lesion. We found that 137 hearts had left atrioventricular valves with three leaflets. The left valve in the other 14 hearts exhibited a dual orifice, a two-leaflet or one-leaflet arrangement, or was imperforate. These anomalies could be analyzed in terms of a sequence of diminishing formation of the commissures. Also, three-leaflet valves displayed a variability in which the angular size of the mural leaflet correlated negatively with that of the inferior leaflet. In some of the hearts with a common atrioventricular orifice, the bridging leaflets did not meet over the ventricular septum, thus creating a "gap." The mural leaflet's angular size corresponded to a deficiency of the combined inferior-mural leaflet complex. Hearts with an abnormal disposition of the left atrioventricular valve had the ventricular septum "scooped" to a greater extent than those with a common orifice, although most had separate right and left atrioventricular orifices.
Heart Septal Defects↗
Educating medical students about death and dying.
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Attitude to Death↗
Superior caval to pulmonary venous fistula--the progenitor of the sinus venosus defect?
An infant with surgically corrected complete transposition of the arteries with intact ventricular septum, a superior caval (sinus venosus) defect, and partially anomalous pulmonary venous connection is described. The morphology of the sinus venosus defect is unusual because the pulmonary to systemic communication is a well-formed extracardiac vein that probably represents a persistence of one of the venous connections normally found in the fetus. This case complements the existing beliefs to how sinus venosus defects are formed and endorses why describing them as atrial septal defects is incorrect.
Fistula↗
The morphology of the normal aortic valve as compared with the aortic valve having two leaflets.
We studied 30 normal aortic valves and 64 aortic valves with only two leaflets to examine their morphologic components. The components of the aortic valve are the leaflets, the sinuses, and the interleaflet triangles. The first part of our study shows the relationship of these component parts of the normal aortic valve to the other cardiac structures. The second part shows a wide variation in the architecture of valves having two leaflets. Having produced criteria for the number of sinuses and the number of leaflets, we discovered that previous criteria used in the definition of valves with two leaflets are inadequate when the whole valvular complex is considered. Only seven valves in the study have two leaflets supported by two sinuses. The evidence points to the other valves having started with three leaflets but becoming bicuspid during either intrauterine or postnatal life.
Adult↗
Symmetrical bronchial pattern with normal atrial morphology.
An infant with trisomy 21 and tracheostenosis is described. Postmortem findings included symmetrical bronchi, normal atrial arrangement ("situs") and anomalous thoracic vessels. The lack of concordance between the bronchial morphology and atrial arrangement supports the premise that atrial morphology is a more accurate predictor of the presence or absence of the isomerism syndromes.
Arteriovenous Malformations↗
Conjoined twins, right atrial isomerism, and sequential segmental analysis.
Three cases of twins conjoined across the chest were examined. In one set, one twin showed right atrial isomerism and the other showed the usual atrial arrangement. The other two sets showed the usual atrial arrangement in both twins. The associated cardiac anomalies were diverse, ranging from atrioventricular septal defects to absent atrioventricular connections. Sequential segmental analysis was used successfully in each case to classify the complex cardiac anomalies. The first step was the recognition of the atrial arrangement. This was easily achieved despite the complexity of the intracardiac morphology.
Female↗
Studies on the nature of fibrillar nuclei. Distinction from viral nucleocapsid.
Despite sufficient evidence to the contrary, fibrillar nuclei continue to be claimed by some to represent paramyxovirus. In a review of the electron-microscopic material, fibrillar nuclei were found in a variety of tissues and situations where a viral etiology is unlikely. Fibrillar nuclei were most often found in postmortem and formalin-fixed material. These nuclei were also experimentally produced in postmortem human lung with formalin fixation followed by a deionized water rinse. It is concluded that fibrillar nuclei do not represent virus, but chromatin, and it is believed that this chromatin appearance is related to cell injury and to tissue processing. It is also believed that fibrillar nuclei occur with much greater frequency than realized. These nuclei are usually ignored during examination of specimens by light and electron microscopy because these specimens are usually being selectively screened for other changes and perhaps because a clear understanding of their significance is still lacking.
Brain↗
Congenitally malformed hearts from a population of children undergoing cardiac transplantation: comments on sequential segmental analysis and dissection.
Our aim is to examine the types of cardiac malformations found in a population of children undergoing cardiac transplantation, and to discuss a method for examining cardiac explants based on intrinsic morphology. We describe in detail the congenital malformations found in 65 cardiac explants acquired from a population of children over a period of 15 years. The specimens were examined and diagnosed using the method of sequential segmental analysis. The most prevalent type of cardiac malformation was severe obstruction of the left heart (29. 2%), followed by double-outlet right ventricle (15.4%), complete transposition (13.8%), hearts with left-hand ventricular topology (10.8%), ventricular septal defect(s) (9.2%), tricuspid valvar agenesis (4.6%), and tetralogy of Fallot (4.6%). These abnormalities accounted for 87.6% of the specimens studied. We also cataloged the extracardiac malformations found at autopsy in those patients who died despite the transplantation. Extracardiac malformations were identified in 10 of the 19 patients who came to autopsy. Three had heterotaxy syndrome with isomerism of the atrial appendages, one with right and two with left isomerism. Other anomalies included tracheoesophageal fistula, pulmonary sequestration, extrahepatic biliary atresia, duodenal atresia, choanal atresia, and vascular malformations.Our study shows that even the most complicated cardiac malformations can readily be diagnosed in an explanted heart using the segmental approach based on observed morphology.
Adolescent↗
Dissection of congenitally malformed hearts, with comments on the value of sequential segmental analysis.
We discuss methods of dissection of the congenitally malformed heart in relationship to the process of sequential segmental analysis. On the basis of our study of an extensive series of malformed hearts, we highlight the lesions that have resulted in faulty dissections and provide some caveats by which these errors can be minimized.
Autopsy↗