• Most explanted (native) hearts are with end-stage heart disease, most commonly secondary to coronary artery disease, myocardial infarct, and cardiomyopathy.
• A meaningful gross examination of an explanted heart should facilitate making an etiological diagnosis of underlying cause.
• Key elements to note: coronary and valvular disease, myocardial hypertrophy and fibrosis, cardiac chamber size. 
• The heart should be weighed and dimensions measured and appearance described (globular).
• Document findings related to previous coronary artery bypass graft (CABG), valve surgery, and ventricular assist devices.
• Examine also status of surgical anastomosis (patency, integrity, stenosis) if it is an allograft heart. They are usually located in the mid portion of the right and left atria and in the pulmonary artery and aorta just above the pulmonic aortic valves.
• Serially cross section from the apex up to the tip of the papillary muscles.  The remaining base portion is cut following blood flow.

• Coronary arteries: sample the segments with occlusion, stenosis, calcification or aneurysm.
• Cardiac valves.
• Myocardium: area of hypertrophy, possible infarct, fibrosis.
• Anastomosis site if allograft heart.

Internal use only

Received unfixed, labeled “Doe, John” and “heart”, is a ___ gm, ___ (apex-base) x __ x __ cm heart with normal configuration / markedly dilated ventricles / . The pericardium is smooth and glistening with the appropriate amount of pericardial fat and a __ cm segment of SVG / LIMA graft bridging left circumflex and LAD. The graft is ___ cm in diameter with a ___ cm diameter patent / stenotic lumen.  The atrial chambers are in normal size / markedly dilated with no fibrin clot. The endocardium is ___ (tan-white) and ___ (unremarkable).  The papillary muscle and cord tendenea are ___ (unremarkable). The cardiac valves are ___ (unremarkable / distorted by fibrosis / calcification) and show ___ (stenosis) with valve circumferences as follows:  aortic – __ cm, pulmonary – __ cm, mitral – ___ cm and tricuspid – ___ cm.  Both ventricular chambers are ___ (normal in size / dilated).  The right ventricular wall measures ___ cm.  The left ventricle shows ___ (concentric hypertrophy / dilatation) with a ___ cm thick free wall except a __ x __ cm area at ___ (the posterior lateral aspect) where the wall is ____ (hemorrhagic / fibrotic) and with a thickness of ___ cm.  The intraventricular septum is  __ cm thick.  The left main coronary artery is fully patent.  The left anterior descending artery is ___ (fully patent / ___% stenosed).  The left circumflex artery is ___ (up to __% stenosed with mural fibrosis).  The right coronary artery is ___ (occluded / 50% stenosed / severely calcified).  The LAD, left circumflex and RCA are ___ (focally calcified).  There is a ___ x __ cm metal wire extending from ___ (the apex of the right ventricle) to ___ (the right atrium ) along ___ (the posteromedial wall).  Representative sections are submitted as follows.

Summary of sections: 

#__ & #__ = left free ventricle, ___(fibrotic / possible infarct area / thinned area) in #__.

#__ & #__ = intraventricular septum,

#__ = right ventricle.

#__ = left anterior descending 4 pieces;

#__ = right coronary artery.

#__ = ___ circumflex artery, 4 pieces;

#__ = anterior papillary muscle, 1 piece;

#__ = posterior papillary muscle, left ventricle, 1 piece;

#__ = aortic valve and aorta, 2 pieces;

#__ = pulmonary valve and pulmonary artery, 1 piece;

#__ = mitral valve

#__ = tricuspid valve.

___ block; ___ H&E slides