Thread by @JulianBurton15

@WKemp_MT_FPDoc @bluehatcomics85 Post-op hearts tend to scare people, but valve replacement is fairly straight forward to deal with at autopsy. There are several things to bear in mind: 1 / n

@WKemp_MT_FPDoc @bluehatcomics85 The causes of death differ between early deaths (within 30 days) and late deaths. Early - typically not due to the valve. Deaths during surgery typically due to operative issues or the pre-existing myocardial damage. 2/n

@WKemp_MT_FPDoc @bluehatcomics85 Things to look for:
▶️ Which valve (s) replaced?
▶️ Replacement type?
▶️ Correct size?
▶️ Correctly sited?
▶️ Leaflets intact?
▶️ Any misplaced sutures?
▶️ Valve thrombosis?
▶️ Vegetations?
▶️ Valve dehiscence?
▶️ Paravalvular leak?
▶️ Paravalvular abscess? 3/n

@WKemp_MT_FPDoc @bluehatcomics85 ▶️ Pannus formation (on ventricular surface)
▶️ Aortic dissection (for AV replacement)
▶️ Don't forget the rest of the heart!
▶️ Any other surgeries - CABG, atriclips etc.
▶️ Bleeding? (100 mL is common and OK)
▶️ Cardiac cannulation sites intact? 4/n

@WKemp_MT_FPDoc @bluehatcomics85 ▶️ Also bear in mind unusual complications such as Mycobacterium chimaera infection, ncbi.nlm.nih.gov/pubmed/29803845 5/n

@WKemp_MT_FPDoc @bluehatcomics85 ▶️ And sternal wound infections and dehiscence - which can result in right ventricular rupture. (The sternum doesn't heal, the right ventricle adheres, and with a cough the ventricle tears resulting in catastrophic haemorrhage)
ncbi.nlm.nih.gov/pubmed/8664001 6/n

@WKemp_MT_FPDoc @bluehatcomics85 Ooops - I feel like I have muscled in on your point and thread. Hope you don't mind!