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The Heart of Frederic Chopin (1810-1849)

2018; Elsevier BV; Volume: 131; Issue: 4 Linguagem: Inglês

10.1016/j.amjmed.2017.12.005

1555-7162

Philippe Charlier, Antonio Perciaccante, Marc Herbin, Otto Appenzeller, Raffaella Bianucci,

Pericarditis and Cardiac Tamponade

We read with interest the paper by Witt et al,1Witt M. Szklener A. Kawecki J. et al.A closer look at Frederic Chopin's cause of death [e-pub ahead of print].Am J Med. 2017; doi:10.1016/j.amjmed.2017.09.039PubMed Google Scholar which details the visual examination of Chopin's heart. The organ is described as massively enlarged and completely covered with whitish, massive fibrillary coating.1Witt M. Szklener A. Kawecki J. et al.A closer look at Frederic Chopin's cause of death [e-pub ahead of print].Am J Med. 2017; doi:10.1016/j.amjmed.2017.09.039PubMed Google Scholar Tuberculous (TB) pericarditis coupled with massive enlargement of the right ventricle, possibly due to pulmonary hypertension, was proposed as the most plausible cause of death of the artist.1Witt M. Szklener A. Kawecki J. et al.A closer look at Frederic Chopin's cause of death [e-pub ahead of print].Am J Med. 2017; doi:10.1016/j.amjmed.2017.09.039PubMed Google Scholar The retrospective diagnosis of probable TB pericarditis was made by the authors based on the identification of three small nodules, between several mm up to 1 cm in diameter, of white-glass appearance, two on an upper part of the ventricle one just near the apex (Figure, A).1Witt M. Szklener A. Kawecki J. et al.A closer look at Frederic Chopin's cause of death [e-pub ahead of print].Am J Med. 2017; doi:10.1016/j.amjmed.2017.09.039PubMed Google Scholar However, these nodules were not examined histologically. Hence, a retrospective diagnosis of TB pericarditis cannot be made with confidence. We, therefore, propose that high-magnification binocular microscopy and computed tomography scanning of Chopin's heart (and eventually magnetic resonance imaging), might reveal important information about the cause of death without resorting to destructive procedures. The red-orange formations (Figure, B)1Witt M. Szklener A. Kawecki J. et al.A closer look at Frederic Chopin's cause of death [e-pub ahead of print].Am J Med. 2017; doi:10.1016/j.amjmed.2017.09.039PubMed Google Scholar are located in proximity or directly on the postautopsy seam and are consistent with blood precipitates or fat fluid precipitation (oozing from the stitches/puncture orifices) coming into contact with an alcohol.2Chung J.Y. Song J.S. Ylaya K. et al.Histomorphological and molecular assessments of the fixation times comparing formalin and ethanol-based fixatives [e-pub ahead of print].J Histochem Cytochem. 2017 Nov 1; (22155417741467 [pii])https://doi.org/10.1369/0022155417741467Crossref PubMed Scopus (22) Google Scholar, 3Werner M. Chott A. Fabiano A. Battifora H. Effect of formalin tissue fixation and processing on immunohistochemistry.Am J Surg Pathol. 2000; 24: 1016-1019Crossref PubMed Scopus (427) Google Scholar The authors claim that the right ventricle is significantly enlarged.1Witt M. Szklener A. Kawecki J. et al.A closer look at Frederic Chopin's cause of death [e-pub ahead of print].Am J Med. 2017; doi:10.1016/j.amjmed.2017.09.039PubMed Google Scholar However, neither the actual size of the ventricles (the atria were destroyed during the autopsy in 1838) nor the thickness of the right and left ventricular walls were measured. From a forensic point of view, the fibrinous deposits on the surface of the heart appear to be postmortem deposits derived from the long-term action of the fixing liquid (high alcohol content).2Chung J.Y. Song J.S. Ylaya K. et al.Histomorphological and molecular assessments of the fixation times comparing formalin and ethanol-based fixatives [e-pub ahead of print].J Histochem Cytochem. 2017 Nov 1; (22155417741467 [pii])https://doi.org/10.1369/0022155417741467Crossref PubMed Scopus (22) Google Scholar, 3Werner M. Chott A. Fabiano A. Battifora H. Effect of formalin tissue fixation and processing on immunohistochemistry.Am J Surg Pathol. 2000; 24: 1016-1019Crossref PubMed Scopus (427) Google Scholar Moreover, the deposits are not widespread over the entire surface of the heart as one would expect if an inflammatory process occurred prior to death. Additionally, postmortem precipitates are gathered where gravity is most effective to accumulate the precipitate that is on flat horizontal surfaces or those showing a slight inclination, for example, the anterior wall of the left ventricle and on the bottom of the jar. This is a classic phenomenon of precipitation of ionic elements (calcium, magnesium, phosphorus) present in the blood, in the lymphatic fluid and in the cytoplasm “sweating” from myocardial dead tissues and also from the large vessels severed at their base (aorta, superior and inferior vena cava, pulmonary artery). A simple rotation of the jar would have shown a complete mobility of such deposits usually found in ancient anatomical specimens. Organs held in the collections of the Dupuytren Museum and the National Museum of Natural History in Paris, which are contemporaries of the heart of Frédéric Chopin, show similar crystalline deposits (Figures A and B). Is Frederic Chopin's Death Elucidated?The American Journal of MedicineVol. 131Issue 4PreviewWe read with interest the article by Witt et al, recently published in the Journal and entitled “A Closer Look at Frederic Chopin's Cause of Death.”1 Full-Text PDF