Niszczota Cezary, Koleśnik Adam, Szymkiewicz-Dangel Joanna
Zaklad Anatomii Prawidłowej i Klinicznej, Centrum Biostruktury, Warszawski Uniwersytet Medyczny, Warszawa.
Ginekol Pol. 2010 Mar;81(3):197-202.
Post-mortem examination of embryos and fetuses becomes increasingly important due to the development of prenatal diagnostic methods. Possibilities of visualization of embryonic and fetal heart in echocardiography and autopsy develops rapidly and due to learning curve there is a need for confirmation of results. There are different methods for visualization of cardiac anatomy. Some morphologists prefer classical histology while others use stereomicroscopy
To develop our own autopsy routine for embryonic and small fetal hearts.
Twenty five normal and malformed fetal hearts aged from 7 to 12 weeks, fixed and unfixed, were submerged in saline solution and dissected using microsurgical instruments. nikon SMZ 1500 microscope, Nikon DS-Fi1 camera and NIS-Elements 3.00 software were used for observation and documentation. The chest was opened by median sternotomy the heart was dissected in situ and sequential segmental analysis was applied.
Detailed anatomy of atriums, interatrial septum, pulmonary and systemic veins drainage were examined. In all cases it was possible to assess morphology of chambers, atrioventricular and ventriculoarterial connections. Congenital heart defect was diagnosed in only 3 out of 25 cases: one in the 10th week of gestation (complete atrioventricular septal defect--CAVSD) and two in the 12th week of gestation (1 case of CAVSD with trisomy 21 confirmed cytogenetically and one of tetralogy of Fallot).
Microautopsy of fetal heart in the 1st trimester of pregnancy is possible using stereomicroscopy and allows us to diagnose congenital heart diseases. Detailed structures are best visible when specimen is unfixed and submerged in saline solution.
由于产前诊断方法的发展，胚胎和胎儿的尸检变得越来越重要。超声心动图和尸检中胚胎和胎儿心脏可视化的可能性迅速发展，并且由于学习曲线的原因，需要对结果进行确认。有不同的方法用于心脏解剖结构的可视化。一些形态学家更喜欢经典组织学，而另一些人则使用体视显微镜。
开发我们自己的胚胎和小胎儿心脏尸检程序。
25个7至12周龄的正常和畸形胎儿心脏，固定和未固定的，浸没在盐溶液中，使用显微外科器械进行解剖。使用尼康SMZ 1500显微镜、尼康DS-Fi1相机和NIS-Elements 3.00软件进行观察和记录。通过正中胸骨切开术打开胸腔，在原位解剖心脏并应用顺序节段分析。
检查了心房、房间隔、肺静脉和体静脉引流的详细解剖结构。在所有病例中，都能够评估心房、房室和心室动脉连接的形态。25例中仅3例诊断为先天性心脏病：1例在妊娠第10周（完全房室间隔缺损——CAVSD），2例在妊娠第12周（1例CAVSD合并21三体综合征经细胞遗传学证实，1例法洛四联症）。
使用体视显微镜对妊娠早期胎儿心脏进行显微尸检是可行的，并且使我们能够诊断先天性心脏病。当标本未固定并浸没在盐溶液中时，详细结构最清晰可见。
