The Operated Heart at Autopsy

After 17 years of private practice as a cardiovascular surgeon, my partners qu- tionedtherationalityofmydecisiontoleavetheclinicalpracticebehindandbecome acardiovascular pathologist.

Infact,theirdisbeliefofmyintentiontomakethe“leap of faith” was understandable.

For a surgeon, the operating room is where the action is.

It is as simple as that. And when a cardiac surgeon can hold in his hand a beating heart, now off-bypass and improved by an operation just completed, satisfaction is real and profound.

However, life is complex. Throughout my surgical career, questions regarding the pathogenesis of atherosclerotic cardiovascular disease arose; curiosities of va- ous phenotypes of the disease piqued my interest.

I became aware of the power of investigative techniques that might address these questions.

I then began to realize that my career in the operating room left me little time to address them.

I needed to study the disease full time in order to contribute to my understanding of it.

Ironically, my ?rst autopsy as a pathology resident was on an individual with a past history of coronary artery bypass surgery.

When it came to examining the heart, the dissection, as all pathologists know, was complex.

However, I found it to be straightforward and enjoyable.

But I subsequently learned that my fellow re- dents and mentors did not share my intrigue and comfort in de?ning the nuances of the operated heart.