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J Thorac Cardiovasc Surg 2005;129:966-969
© 2005 The American Association for Thoracic Surgery

Editorials

Evolving role of cardiovascular pathology in clinical and surgical decision making

Gaetano Thiene, MD, FRCP*,*

Department of Pathology, University of Padua Medical School, Padua, Italy

Received for publication July 14, 2004; accepted for publication July 30, 2004.

* Address for reprints: Gaetano Thiene, MD, FRCP, Istituto di Anatomia Patologica, Università degli Studi di Padova, Via A. Gabelli, 61, 35121 Padova, Italy (E-mail: gaetano.thiene@unipd.it).

The first 300 words of the full text of this article appear below.


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  		Dr Thiene

 
When I was still a student in the late 1960s and started following the call for cardiovascular pathology, the job was restricted mostly to autopsy. This discipline was the Cinderella within the large family of anatomic pathology, and the reason was that it dealt only with cadavers.

Cardiac surgery was just starting, and there was high operative mortality. The cardiovascular pathologist was asked to perform autopsies on surgical fatalities, bearing witness to limitations in medical knowledge. Cardiopulmonary bypass and cardiac arrest allowed the surgeons to open the heart and correct the defects, being still unaware of elementary morphologic notions, such as the topography of the conduction system. Most of the septal defects first operated on at the Mayo Clinic with the use of a cardiopulmonary bypass machine were weaned off the pump with atrioventricular block.1

Operable cardiac diseases consist of gross structural defects, and clearly the mission of the pathologist was to support the clinicians and surgeons by transferring the postmortem information into knowledge of clinical and surgical anatomy to improve the diagnosis and treatment for the benefit of the patient. The anatomic theater was still the place mors ubi gaudet succurrere vitae (where death enjoys to help life).2

It soon became evident that the cardiologist, the cardiac surgeon, and the cardiovascular pathologist should possess a similar cultural background, despite different professional duties. The catheterization laboratory, the surgical theater, and the autopsy room were places where the same teaching and language for fruitful clinicopathologic correlations were applied.3

After improvements in anesthesiology and myocardial-cerebral protection during cardiac arrest, which rendered operations feasible in neonates,4 a sound knowledge of the anatomy of complex congenital heart disease appeared to be a prerequisite for optimizing clinical diagnosis and improving surgical repair. Implementation of a cardiac registry of congenital heart disease specimens allowed . . . [Full Text of this Article]






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