A sudden infant death associated with atrial septal aneurysm and abnormality of the connecting site between the inferior vena cava and right atrium. (September 2022)

• Record Type: Journal Article
• Authors: Takada, Aya; Saito, Kazuyuki; Takahashi, Shirushi; Sakai, Kentaro; Yoneyama, Katsumi; Nakanishi, Hiroaki
• Is Part Of: Legal medicine. Volume 58(2022)
• Publication Date: 2022-09
• Subjects: Atrial septal aneurysm -- Inferior vena cava -- Infant -- Sudden infant death -- Congenial heart disease; Medical jurisprudence -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Medical jurisprudence; Periodicals; 614.1
• DOI: 10.1016/j.legalmed.2022.102089
• Languages: English
• ISSNs: 1344-6223

Abstract

Highlights: A rare huge atrial septal aneurysm (ASA) was presented in a sudden infant death case. The inferior vena cava (IVC) of the infant showed abnormal connection to the right atrium. The abnormal connection of IVC might have affected the development of ASA. A certain type of ASA is suggested to have pathological significance. Abstract: An atrial septal aneurysm (ASA) is a rare cardiac anomaly characterized by varicose bulging of the atrial septum (oval fossa) into the left or right atrium. Pathogenesis and clinical significance of ASA are controversial. We report an autopsy case of a huge undiagnosed ASA with abnormality of the connecting site between the inferior vena cava and the right atrial ostium in a 2-month-old Japanese female who died suddenly and unexpectedly. She was born at 36 weeks 4 days (body weight 3, 110 g). No abnormality was detected during pregnancy or delivery. The postnatal growth was normal with no cardiac problem detected at the 1-month checkup. The ASA bulged off in a mass to the left atrium (width, 0.8 cm; excursion ratio, 53%), reaching close to the inflow site of the right pulmonary vein, with dilation of the pulmonary vein. The connecting site between the inferior vena cava and the right atrium was atypically located 1.6 cm away from the atrioventricular groove. Although most cases of ASA in an infant resolve physiologically as the infant grows, the infant in the present case is thought to have had an exceptional pathological ASA, possibly causing supraventricular arrhythmia. The abnormality of the connecting site between the inferior vena cava and the right atrium might have affected the development and continuation of the ASA.