In this episode Dr. Isles proves to be somewhat less than competent when it comes to careful clinical observation of a corpse prior to beginning an autopsy. When the young woman who died is autopsied by Dr. Isles, she indicates to Detective Rizzoli that she is surprised to find that the woman has had a heart valve replacement. She says that she thought the woman had died of, if I recall correctly, a 'heart attack', but the autopsy revealed that she had had a cardiac valve replacement, with a valve that subsequently proved to be defective which led to her death. What the writers and thus Dr. Isles obviously overlooked was the fact that if the woman had undergone a cardiac valve replacement, she would have exhibited a median sternal scar, indicating where the median sternotomy (splitting of the sternum) had been done to expose her heart prior to her being placed on cardiac bypass while her defective valve was replaced. This is the type of scar that is exceedingly difficult to disguise completely or miss at autopsy since it extends from the sternal notch at the base of the neck right down to the tip of the xiphoid (lower end of the sternum) and being this long, it seldom, if ever, heals to such an extent that it will no longer be visible, especially to a pathologist like Dr. Isles who supposedly has done many, many autopsies. In addition, at the conclusion of the operation the split sternum is usually brought into apposition using reasonably heavy wire sutures which remain permanently in place and buried in the sternum. Dr. Isles would have had to be blind to have missed these metal sutures on a pre-autopsy X-Ray as well as when she opened the chest using the common 'Y' autopsy incision and chest opening.
This is not a major errpr but just something that stuck out like the proverbial 'sore thumb' when I heard her dialogue. Trials are now underway of a new valve design that can be inserted via intravascular instrumentation thus requiring no thoracic (chest) incision or opening but since the valve referenced in this episode had been in use for several years, it would not have been of that design. The show's medical consultant ought to be a bit ashamed of him/herself for making this obvious mistake.
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