Go Inokuchi, Daisuke Yajima, Mutsumi Hayakawa, Ayumi Motomura, Fumiko Chiba, Suguru Torimitsu, Yohsuke Makino, Hirotaro Iwase
Nuevo artículo en el que se demuestra la utilidad de las pruebas complementarias para el apoyo al Médico Forense en el diagnóstico de la causa de la muerte, dentro de lo que se conoce como Virtuopsias.
En este caso nos encontramos ante la utilidad de realizar una angiografía coronaria del corazón aislado, combinándola con una tomografía computerizada para establecer el diagnóstico de la estenosis coronaria sufrida por el cadáver y que ha podido ser la causa de la muerte.
Historically, coronary angiography of the isolated heart has played an important role in the detection of stenotic or occlusive lesions that are difficult to identify by autopsy alone. Meanwhile, although the application of multidetector computed tomography (MDCT) to forensic fields has accelerated recently, isolated single organ angiography with MDCT is rarely performed. In this article, we present an evaluation of postmortem selective coronary CT angiography of the isolated heart with MDCT and discuss its utility for autopsy. First, in a preliminary experiment using pig coronary artery, we examined the behavior of water soluble contrast material on postmortem computed tomography angiography (PMCTA) and found that better angiographic images were acquired when the viscosity of the contrast material was increased and CT was performed under conditions of sustained perfusion. Based on these results, we devised a selective coronary angiography procedure using a pressurized bag for drip infusion that can be performed easily, quickly, and at low cost. The angiographic images obtained provided useful supportive evidence of autopsy findings suggestive of ischemic heart disease. With active discussions underway in forensic fields on the proper use of postmortem computed tomography, PMCTA has also naturally attracted attention as it compensates for some of the shortcomings of CT alone. Although PMCTA typically involves whole-body angiography, if we view PMCTA as one of the many useful and supplementary tools available for autopsy, then isolated heart angiography continues to have utility in autopsy today.
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