心脏瓣膜置换术后死亡案例的法医病理学分析

目的 分析心脏瓣膜置换术后死亡案例的法医病理学特点,探讨有关瓣膜置换术后死亡案例的法医病理学鉴定思路及原则.方法 从手术方式、术前心脏状况及术中所见、法医病理检验所见、死亡时间、死亡原因等方面,对2008年1月-2010年2月4例心脏瓣膜置换术后死亡案例进行综合研究分析.结果 4例均患有风湿性心脏病,且术前心功能较差;...

Forensic Pathological Analysis of Death Cases after Cardiac Valve Replacement

Objective To analyze the forensic pathological characteristics of those who died after cardiac valve replacement and explore the mentality and principle of documentary evidence of medicolegal expertise.Methods Four death cases after cardiac valve replacement between January 2008 and February 2010 were comprehensively analyzed from various aspects of surgery style,preoperational heart condition,peri-operational observations,results of forensic pathological tests,time of death,and causes of death.Results All cases were rheumatic heart disease and the preoperational heart function was poor.Of the four cases,three had mitral valve replacement（MVR）,three had aortic valve replacement（AVR） and two had tricuspid valvuloplasty.Of the three MVR cases,cutting on the left atrium paralleling the interatrial groove was performed in one case,cutting through right atrium and interauricular septum was performed in one case,and cutting left atrium and right atrium through interauricular septum was performed in another case.For all the three AVR cases,cutting on the root of aorta with the shape of diagonal or ’S’ was carried out.One patient died during operation,one died thirty minutes after operation,one died two days after operation and one died eight days after operation.Among them,one died of myocarditis,one died of hemorrhage in the conducting system and two died of hemorrhagic shock.Besides,one patient had potential bacterial infection before surgery.Conclusion For patients who died after cardiac valve replacement,we should acquaintance ourselves with the preoperational heart condition,surgery style,surgical approach and the methods of stitch to make a comprehensive analysis with forensic pathology examination.