Virtual Post Mortem in Fetuses and Newborns for the Verification of Congenital Heart Malformations.

Abstract

Post-mortem examinations of fetuses and newborns with congenital anomalies pose significant challenges, especially in cases of induced termination of pregnancy. To address this, we explored the use of virtual post-mortem examination (VPM) via computed tomography angiography (CTA) as a potential alternative. The study was conducted at Sheba Medical Center from January 2013 to June 2019. It focused on 20 cases involving severe congenital heart defects or lung malformations affecting the heart. VPM imaging was performed using CTA with contrast medium injected into the umbilical artery and vein. Prenatal sonographic diagnoses were fully concordant with VPM findings, confirmed by authorized invasive autopsies in 7 cases. The standardized injection protocol enabled accurate imaging of the systemic and pulmonary vessels, aiding in the identification of vascular anomalies and the cardiac structures. However, visualization of intra-cardiac anatomy was limited, possibly due to valve competence and post-mortem intra-ventricular Thrombi. Compared to MRI, CT scans this method offers higher spatial resolution at a lower cost, making it a feasible complement to standard medical practice. Despite limitations in visualizing cardiac chambers, VPM with umbilical vessel injection proved highly accurate, particularly in assessing the great vessels. Overall, the findings suggest that VPM may offer a less invasive and acceptable alternative for grieving parents, providing valuable insights into complex congenital cardiac anomalies, while respecting the sensitivity of post-mortem examinations in such cases.