DIAGNOSTIC UTILITY OF SHORT AXIS METHOD OF HEART DISSECTION VERSUS INFLOW OUTFLOW METHOD IN SUDDEN CARDIAC DEATH

Background and Objectives:Cardiac pathology is responsible for 80% of sudden deaths. Inflow outflow method is the most commonly used method of heart dissection which often fails to find out cause of death. Triphenyltetrazolium chloride staining is used for macroscopic diagnosis of early infarcts. Objectives of the study was to assess the diagnostic utility of short axis method over inflow outflow method of heart dissection, to assess the necessity of Triphenyltetrazolium chloride staining to pick up acute MI of 2-6hrs. Methods:60 cases of sudden cardiac deaths were studied inDepartment of Pathology, Bangalore MedicalCollege & Research Institute, Bangalore. 30 cases were dissected by inflow outflow method and 30 cases were dissected by short axis method. Triphenytetrazolium chloride staining was done on fresh hearts to detect early infarcts. Morphometric analysis was done to assess myocyte diameter in case of HCM. Results:Study included 56 males and 4 females. The commonest cause of sudden cardiac death in our study was ischaemic heart disease (50%), non-ischaemic sudden cardiac deaths occurred in hypertrophic obstructive Cardiomyopathy (8.3%), arrythmogenic right ventricular dysplasia (1.6%), mitral valve prolapse (1.6), mitral stenosis (5%), coronary artery dissection (1.6%) and others (8.3%). Triphenyltetrazolium chloride showed infarcts grossly which was confirmed by histology. Interpretation and Conclusions:Short axis method of heart dissection is better method for finding infarcts, cardiomyopathies, biventricular hypertrophies and myocarditis. Triphenyltetrazolium chloride staining is sensitive and specific method for finding out early infarcts. Masson trichrome is excellent in finding out fibrosis in case of HCM and chronic IHD.