Auto Text: “Insert Heart Explant”

Triage

1. Weigh.
2. Photograph the external surface of the heart in the fresh state.
3. Examine and describe epicardial surfaces.
4. Stuff all chambers with formalin-soaked gauze and submerge heart in formalin overnight.
5. Do not remove any hardware or leads, in particular, from the specimen.

Gross

Show all explants to Thoracic fellow, Dr. Husain or Dr. Moskowitz prior to grossing.

Ischemic Heart Disease

1. Take gross photographs of the intact heart (anterior and posterior).
2. Document and describe any attached or separately received hardware.
3. Place all hardware in a separate container with a new patient label and give to an AP tech for return to the electrophysiology laboratory.
4. Describe the external aspect of the heart.
5. Serially section each coronary artery in 2 mm increments (RCA, L main, LAD, LCX) and bypass grafts, if any.
6. Decal arteries before sectioning, if necessary.
7. Note the percentage of luminal compromise of each artery and graft.
8. Serially section the heart transversely – 1 cm thick beginning at the apex of heart and extending to the level of the mitral valve.
9. Cut remainder of heart along the lines of blood flow (RA, RV, PA, LA, LV, aorta).
10. Look for scars, infarcts, aneurysms, bypass grafts.  Note their locations and sizes.
11. Measure thickness of ventricles and valve circumferences.
12. Take gross photograph of cut sections.
13. Submit representative sections of each artery, vascular graft(s) if present, left ventricle (base, mid, and apex), right ventricle (base and apex), interventricular septum (base and apex), and lesions (at least one section of each).

Nonischemic Cardiomyopathy (Dilated, Hypertrophic)

1. Take a gross photographs of the intact heart (anterior and posterior).
2. Document and describe any attached or separately received hardware.
3. Place all hardware in a separate container with a new patient label and give to an AP tech for return to the electrophysiology laboratory.
4. Describe the external aspect of the heart.
5. Serially section each coronary artery in 2 mm increments (RCA, L main, LAD, LCX).  These are usually normal (non-atherosclerotic).
6. Bisect longitudinally from apex to base in a “FOUR CHAMBER CUT” – bisect atria and ventricles through tricuspid and mitral valves.
7. Take gross photographs of both halves.
8. 
9. Assess chamber sizes (normal, enlarged, decreased).
10. The heart may have different degrees of hypertrophy and dilation.
11. Look for subendocardial scars, mural thrombi, aneurysms.  Note their location and size.
12. Measure thickness of ventricles and valve circumferences.
13. Submit representative sections of each artery, left ventricle (base, mid, and apex), right ventricle (base and apex), interventricular septum (base and apex), and lesions (at least one section of each).

Congenital Heart Disease

1. Call Thoracic fellow and Dr. Husain or Dr. Moskowitz before all cases.

Updated SRR 6/26/23