1/11. pathology of the heart and conduction system in a case of sudden death due to a cardiac fibroma in a 6-month-old child.A 6-month-old female infant considered to be in good health died suddenly and unexpectedly. Post-mortem examination was requested, with clinical diagnosis of sudden infant death syndrome. Gross examination revealed, however, the presence of a cardiac mass 4.5 X 4 x 3.5 cm in diameter. Histological examination of the heart confirmed the presence of a cardiac fibroma. In the present case, the sudden death could have been due to the left ventricular outflow obstruction, as much as to conductive disturbances caused by overstretching and compression of the atrioventricular node and of the bundle branches. Hemodynamic and conductive abnormalities are presumed to have provoked bradycardia degenerating into ventricular fibrillation and sudden death. Necroscopy studies of sudden death should always include histological examination of the cardiac conduction system but seldom do.- - - - - - - - - - ranking = 1keywords = conduction (Clic here for more details about this article) |
2/11. Inflammatory changes in the cardiac conducting system in sudden infant death syndrome.A case is reported of a sudden death syndrome in an infant in which there was evidence of inflammation in the atrioventricular conduction system and the right atrial wall- - - - - - - - - - ranking = 0.2keywords = conduction (Clic here for more details about this article) |
3/11. Multifocal cardiac Purkinje cell tumor in infancy.Cot death is the commonest form of death among babies in the first year of life. The authors report the unusual case of a 2-month-old female infant dying suddenly and unexpectedly in whom a postmortem histological examination demonstrated a cardiac multifocal Purkinje cell tumor. Necroscopy studies of sudden infant death should always include an accurate histological examination of the cardiac conduction system and brainstem using serial sections.- - - - - - - - - - ranking = 0.2keywords = conduction (Clic here for more details about this article) |
4/11. sudden infant death triggered by dive reflex.The dive reflex is the reflex mechanism most frequently considered in the aetiopathogenesis of sudden infant death syndrome (SIDS). This seems to persist in human beings as an inheritance from diver birds and amphibians. It has been reported that washing the face with cold water or plunging into cold water can provoke cardiac deceleration through the intervention of the ambiguus and the vagal dorsal nuclei. This report describes a case of SIDS that offers a unique insight into the role of the dive reflex in determining a lethal outcome. Examination of the brainstem on serial sections revealed severe bilateral hypoplasia of the arcuate nucleus and gliosis of the other cardiorespiratory medullary nuclei. The coronary and cardiac conduction arteries presented early atherosclerotic lesions. The possible role of parental cigarette smoking in the pathogenesis of arcuate nucleus hypoplasia and early coronary atherosclerotic lesions is also discussed.- - - - - - - - - - ranking = 0.2keywords = conduction (Clic here for more details about this article) |
5/11. sudden infant death syndrome "gray zone" disclosed only by a study of the brain stem on serial sections.sudden infant death syndrome (SIDS) "gray zone" or borderline cases are defined as those cases in which it is difficult to establish whether the pathological findings are sufficiently severe to have caused the death. Examination of the brainstem in 103 cases of SIDS disclosed five SIDS "gray zone" cases in which only further investigations of serial sections successfully identified anatomico-pathological findings that likely represent the morphological substrates for a sudden reflexogenic death. A complete autopsy was performed, including close examination of the brainstem and cardiac conduction system, according to our guidelines. Our five cases are consistent with the triple-risk model of SIDS, a hypothesis postulating an underlying biological vulnerability to exogenous stressors or triggering factors in a critical developmental period. Inflammatory infiltrates (cases 1 and 2), necrotic focus of the solitary tract (case 3), hemangioendothelioma (case 4) and mild pneumonia (case 5) alone might or might not have accounted for the sudden deaths, if it had not been for the location and/or concomitant presence of brainstem abnormalities that could have had a triggering role in causing the sudden death of these babies.- - - - - - - - - - ranking = 0.2keywords = conduction (Clic here for more details about this article) |
6/11. sudden infant death syndrome (SIDS) shortly after hexavalent vaccination: another pathology in suspected SIDS?Experts from panels of the European Agency for the Evaluation of Medical Products have investigated whether there might be a link between hexavalent vaccines and some cases of deaths that occurred. Participants included pathologists with experience in the field of vaccines and sudden infant death syndrome who conducted autopsies. However, to the best of our knowledge, little, if any, attention was paid to examination of the brainstem and the cardiac conduction systems on serial sections, nor was the possibility of a triggering role of the vaccine in these deaths considered. Herein we report the case of a 3-month-old female infant dying suddenly and unexpectedly shortly after being given a hexavalent vaccination. Examination of the brainstem on serial sections revealed bilateral hypoplasia of the arcuate nucleus. The cardiac conduction system presented persistent fetal dispersion and resorptive degeneration. This case offers a unique insight into the possible role of hexavalent vaccine in triggering a lethal outcome in a vulnerable baby. Any case of sudden unexpected death occurring perinatally and in infancy, especially soon after a vaccination, should always undergo a full necropsy study according to our guidelines.- - - - - - - - - - ranking = 0.4keywords = conduction (Clic here for more details about this article) |
7/11. Prolonged QT interval and cardiac arrhythmias in two neonates: sudden infant death syndrome in one case.Two neonates with arrhythmias and the long qt syndrome are described. The arrhythmias were detected in utero and both infants were apparently well after birth. The first infant, although well, had a bradycardia for the first 9 days of life. A normal heart rate was documented at 10 days but a prolonged QT interval was not appreciated on the ECG. He was discharged from hospital but died suddenly and unexpectedly 3 days later. A post-mortem examination failed to find a cause for his death which therefore fell into the category of the sudden infant death syndrome (SIDS). A retrospective analysis of the perinatal electrocardiogram showed a probable junctional rhythm with 2:1 conduction to the ventricle; the QT interval was prolonged at 0.52 seconds (QTC = 0.63). The second infant had a QT interval of 0.52 seconds (QTC = 0.54) and frequent ventricular premature beats on a 24-hour electrocardiogram. She was treated with propranolol and remains well 2 years later. sudden infant death has often been described in the siblings of children with the long qt syndrome and one other report described a case of SIDS which was said to have had a prolonged QT interval on the perinatal ECG. This report, however, provides unquestionable evidence, in one case, of an association between the long qt syndrome and SIDS.- - - - - - - - - - ranking = 0.2keywords = conduction (Clic here for more details about this article) |
8/11. Abnormal heart rate response during newborn sucking behavior study: subsequent sudden infant death syndrome with cardiac conduction abnormality.This report concerns a four-month-old white female infant who exhibited abnormal feeding behavior and EKG irregularities during a newborn sucking behavior study. The immediate post-birth history showed an irregular heart rate on two occasions, but a cardiac consultation elicited no unusual findings. During sucrose sucking conditions, the heart rate increased with a beat-to-beat variation of 50 beats per minute, noted to be due to premature atrial beats. At 39 days, an EKG showed a marked sinus tachycardia of 156, a PR interval of 0.08, QRS of 0.05 and a QT of 0.26. The infant was diagnosed as a sudden infant death syndrome (SIDS) following an unexpected death at home. Subsequent cardiac pathology revealed an anomalous tract between the right atrium and the atrioventricular (AV) bundle which formed an extensive bypass of the AV node (atrio-His tract), and two accessory AV connections between the left atrium and posterior left ventricle. These findings are consistent with the wolff-parkinson-white syndrome type A. Only further studies can determine whether such abnormal feeding behavior with EKG irregularities can be used to identify infants who are at high risk for sudden death.- - - - - - - - - - ranking = 0.8keywords = conduction (Clic here for more details about this article) |
9/11. heart block and sudden death associated with fibrosis of the conduction system at the margin of a ventricular septal defect.Isolated ventricular septal defects in clinically well patients are not generally thought to cause sudden death. We document a case in which heart block, with sudden collapse and death, is related to the presence of fibrous interruption of the conduction system of the heart due to progressive fibrous closure of a small ventricular septal defect.- - - - - - - - - - ranking = 1keywords = conduction (Clic here for more details about this article) |
10/11. Cardiac conduction disorders in six infants with "near-miss" sudden infant deaths.Cardiac conduction disorders caused sudden serious illnesses in six infants that might have been fatal if diagnosis and treatment had been delayed. These cases provide circumstantial evidence to support a link between cardiac conduction disorders and some sudden infant deaths. A further potential long-term effect of these disorders is illustrated in one child in whom psychomotor retardation seemed to develop after an episode of cerebral hypoxia that was probably by an arrhythmia associated with the wolff-parkinson-white syndrome. Cardiac conduction disorders may be detected by routine neonatal ECG screening, and it may therefore be appropriate to start prophylactic antiarrhythmic treatment in certain children before clinical signs develop.- - - - - - - - - - ranking = 1.4keywords = conduction (Clic here for more details about this article) |
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