At autopsy the pericardial cavity was opened to reveal
500 cc of dark red partially clotted blood.
The epicardium revealed diffuse fibrinous pericarditis over nearly
the entire surface to a maximal thickness of 0.7 cm.
The apical surface of the heart was hemorrhagic and very thin.
Sections through the heart and coronary
arteries confirmed the stent placement with continued severe occlusion
of the LAD just distal to the stent. There was moderate occlusion
of the mid third of the LAD. There was a left dominant system with
patent left circumflex and right coronary arteries.
Coronary arteries at autopsy
1. Sectioning through the left main artery at the site of the stent
insertion into the left anterior descending artery shows that the
vessel is patent.
2. Additional serial sections through the LAD show the stent in
place and regions of severe atherosclerosis.
3. Close up of the distal region of the stent showing severe narrowing
of the vessel.
4. Mid portion of the LAD distal to stent showing second area of
narrowing.
5. Section of the LAD with near total occlusion by calcified atheroma
just distal to the stent.
A massive infarction consistent with total
occlusion of the LAD was found with extreme thinning of the LV at
the apex and covering the majority of the left ventricular free wall.
There was massive myocardial infarction of the left ventricle
1. The heart is opened showing the left ventricle. There is a
massive transmural infarction extending around the entire free wall.
2. Close up of the left ventricular free wall with small residual
area of viable myocardium.
3. Apex of the heart with complete loss of myocardium.
4. Low power microscopic section of the left ventricular apex with
loss of myocardium and hemorrhage into epicardial fat.
5. Medium power showing residual myocardium with hemorrhage.
On cut sectioning, the hepatic parenchyma contains a faintly nodular
pattern and nutmeg staining.
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