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Valve pathology: a dying trade
  1. Mary N Sheppard
  1. Royal Brompton & Harefield NHS Trust, London, UK
  1. Correspondence to Dr Mary N Sheppard, CRY Centre for Cardiac Pathology, Imperial College London, SW3 6NP, UK; m.sheppard{at}rbht.nhs.uk

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At present, there are only a handful of cardiac pathologists in the UK and we have recently had several retiring. There are no full time academic cardiac pathologists. Most pathologists carrying out autopsies will be familiar with the heart and ischaemic heart disease since this is the main cause of death in the developed world. However, when it comes to non-ischaemic heart disease, the general pathologist is on less firm ground. There has been a marked fall in hospital autopsy rates in both USA and UK1 and general pathologists are doing fewer cases during their training, so their knowledge is by necessity limited. It is useful to remember that pathologists found the study of the whole heart removed at autopsy gave them many of the advances in congenital heart disease, cardiomyopathies and atherosclerosis. Most of us tend to forget that many of the major advances in heart surgery in both children and adults only came about from what was learnt at postmortem. It is essential to continue to nurture expertise in cardiovascular pathology. Without this specialist knowledge, how are we to understand the evolving mechanisms of atherosclerosis, hypertension, cardiomyopathies, sudden cardiac death, heart failure and transplantation. With the decline in the autopsy rate, we no longer have access to material for research and genetic analysis and yet genetic investigations are becoming an essential part of cardiac pathology as we are finding that more and more diseases are inherited.2 There has been rapid advances in cardiac procedures particularly for our ageing population. How are we to understand the consequences of new procedures such as angioplasty and stent insertion, ablation for cardiac arrhythmias, transcatheter replacement of aortic valves (eg, transcatheter aortic valve implantation) or the use of the transcatheter mitral clip to treat mitral regurgitation? Clinical knowledge and expertise are …

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