Elsevier

Legal Medicine

Volume 22, September 2016, Pages 1-4
Legal Medicine

Case Report
Sudden infant deaths from undiagnosed ventricular septal defect – Report of two autopsy cases

https://doi.org/10.1016/j.legalmed.2016.07.002Get rights and content

Highlights

Abstract

Ventricular septal defect (VSD) has a relatively non-aggressive clinical course; either spontaneous closure or causing congestive heart failure treatable with surgical intervention. We present two autopsy cases of sudden infant deaths from clinically undiagnosed VSDs. Case 1 was an 18-day-old boy. As the deceased coughed and became limp after feeding, he was carried to a hospital. Heart murmur was not auscultated there, so he was brought back to home. He presented severe dyspnea and then he was pronounced dead the next day. Case 2 was a 3-week-old boy. Any abnormality was pointed out at physical examination, although his mother felt his wheeze. He developed respiratory arrest at home in the morning and then he was confirmed dead at the hospital. Heart weights of these babies were heavier than mean weights of each normal development. There were perimembranous VSDs in both cases. Histology revealed that the pulmonary arterial walls were thickened. We diagnosed the cause of death in these cases was cardiac collapse with pulmonary hypertension due to VSD. Congenital heart diseases can be diagnosed as early as before birth, because echocardiograph and fetal echography are prevalent in these days. Most VSDs can be noticed by systolic murmur even today. We consider that the failure of initial clinical diagnosis of VSD in primary physical assessment could lead unexpected sudden death. These two cases reminded us to the importance of auscultation which is conventional but as one of the indispensable measure to find a clue for the congenital abnormality.

Introduction

Ventricular septal defect (VSD) is one of the most common congenital cardiac diseases. Some authors recently reported higher incidence as 43.6–46.3 [1], [2], although the incidence of VSD have been reported between 2 and 6 per 1000 live births in the past [3], [4]. Researches in Japan have found 6.0–24.4 [5], [6], [7], [8]. Majority of VSD cases has relatively non-aggressive clinical courses; either spontaneous closure or causing congestive heart failure treatable with surgical intervention. Systolic heart murmur usually triggers an awareness of VSD [9]. Some patients, on the other hand, can be diagnosed as VSD earlier using echocardiography or lately after showing symptoms of heart failure. Here we report two autopsy cases of VSD that were not diagnosed antemortem.

Section snippets

Case 1

The patient was an 18-day-old boy. He was born at 40 weeks and 2 days of gestation with a weight of 2904 g, and had no notable previous or family history. He experienced coughing after feeding in his 17th day. He was carried into an emergency unit because he manifested weakness. Heart murmur was not auscultated during physical examination according to the medical record. Any problem was not pointed out except tachypnea and peripheral coldness. His mother breastfed him twice after getting home,

Discussion

Growth and development of both the patients were sufficient. No lethal injuries or major abnormalities except VSD were found. There were no significant results in serum viral antibody titers and cultivation tests of blood and spinal fluid or swab from the respiratory tract, as far as we investigated. No inflammatory lesion was found in any organ in either of the cases. Possibility of fetal infection was thus excluded.

The hearts weighed 42.0 g in case 1 and 36.6 g in case 2, which were heavier

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