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Sudden cardiac death due to an anomalous posterior papillary muscle.
MedLine Citation:
PMID:  20190632     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Anomalies of the mitral subvalvular apparatus can include differing types of papillary muscles and chordae tendinae. Direct insertion of the anomalous papillary muscle or chordae tendinea into the anterior mitral leaflet and fusion to the ventricular septum are common findings related to these anomalies. Anomalous papillary muscles or chordae, especially those that insert directly into the mitral leaflets, play a role in obstructing left ventricular outflow by restricting the mobility of the leaflets and/or tethering them toward the septum, thus narrowing the left ventricular outflow tract (LVOT). The incidence of mitral valve anomalies associated with LVOT is probably underestimated. This topic is frequently studied, however, especially in the pediatric cardiac surgery milieu, because LVOT obstruction could have a surgical solution. We report a case of an 18-year-old woman affected by epilepsy since 5 months of age who was found dead in her bedroom. An uncommon anomalous papillary muscle/chordae was the main autopsy finding. This malformation causes direct continuity between an accessory papillary muscle and a mitral leaflet, resulting in a long rigid area that can cause dynamic late-systolic intraleft-ventricular obstruction. In our case, in the absence of any other pathologic findings or major structural abnormalities, we speculate that a malignant cardiac arrhythmia provoked by the accessory papillary muscle could be the cause of death.
Authors:
Francesca Cittadini; Antonio Oliva; Vincenzo Arena; Natalia Minelli; Vincenzo L Pascali
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of forensic medicine and pathology     Volume:  32     ISSN:  0195-7910     ISO Abbreviation:  Am J Forensic Med Pathol     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2013-09-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8108948     Medline TA:  Am J Forensic Med Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  239-41     Citation Subset:  IM    
Affiliation:
From the *Institute of Forensic Medicine, and †Institute of Pathology, Catholic University, School of Medicine, Rome, Italy.
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