PICturing coronary pathology postmortem: forensic cardiac imaging with Postmortem Infrared Coronary angiography of human heart ex situ

Abstract

The diagnostic assessment of sudden and unexpected cardiovascular deaths remains intricate in forensic medicine. Building upon the foundational technique introduced by P. Fais et al.(2018), we present modifications to the post-mortem infrared coronary angiography (PIC) tailored specifically for the assessment of human hearts. Refinements to PIC encompass the integration of a 3D-printed clamp for catheter stabilization and the procedural alteration of utilizing warm water injections, negating the need for additional cardiac cooling. An enhanced imaging modality is achieved using the FLIR Thermal Lepton 3.5 camera, embedded within the robust Cat S62 Pro mobile device, ensuring optimal resolution and suitability for an autopsy environment. The advanced PIC technique provides superior visualization of the coronary arteries, frequently correlating with subsequent autopsy and histological assessments. Notably, the method allows immediate continuation to the autopsy without compromising the cardiac structure. Nevertheless, certain anatomical variances, such as muscular bridging or pronounced pericardial fat, might reduce locally what appears to be an otherwise excellent specificity. The refined PIC method emerges as a pivotal diagnostic adjunct in forensic evaluations of sudden cardiovascular fatalities. Its ability to preserve cardiac integrity and facilitate uninterrupted autopsy progression underscores its potential utility. However, rigorous validation is imperative to ascertain its comprehensive applicability and inherent limitations.