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Bifid cardiac apex in a 25-year-old male with sudden cardiac death
Cardiovascular Pathology 23 (2014) 59–60
Contents lists available at ScienceDirect
Cardiovascular Pathology
Images in Cardiovascular Pathology
Bifid cardiac apex in a 25-year-old male with sudden cardiac death Annie Wu a,⁎, Deborah Kay a, Michael C. Fishbein b a b
Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, UCLA Center for the Health Sciences 13-145, Los Angeles, CA 90095-1732, USA Department of Health, Office of the Chief Medical Examiner, Richmond, VA 23219, USA
a r t i c l e
i n f o
Article history: Received 23 January 2013 Received in revised form 26 June 2013 Accepted 26 June 2013 Keywords: Bifid cardiac apex Sudden cardiac death
a b s t r a c t Although a bifid cardiac apex is common in certain marine animals, it is an uncommon finding in humans. When present, bifid cardiac apex is usually associated with other congenital heart anomalies. We present a case of bifid cardiac apex that was an incidental finding in a 25-year-old male with sudden cardiac death from combined drug toxicity. On gross examination, there was a bifid cardiac apex with a 2-cm long cleft. There were no other significant gross or microscopic abnormalities. This case represents the very rare occurrence of a bifid cardiac apex as an isolated cardiac anomaly. © 2014 Elsevier Inc. All rights reserved.
The bifid cardiac apex is a rare entity that in humans has only been reported in cases with other congenital cardiac defects present as well [1–3]. Bifid apex is commonly found in marine mammals and is postulated to be characteristic of certain species such as the sperm whale and Florida manatee [4]. In human embryonic development, a cardiac notch indicating the site of the developing interventricular septum is usually seen between the fifth and eighth week of gestational age [1]. This notch disappears by the 11th week of gestation, and its postnatal persistence is likely the precursor to a bifid cardiac apex [1]. We have encountered a case where a bifid cardiac apex was an incidental discovery without any other cardiac anomalies. The heart was of a 25-year-old African-American male with sudden death from a combined methadone and alprazolam toxicity. The patient was 66.5 in. tall and weighed 132 lb. No other clinical history of the decedent was known at the time of examination. The heart weighed 305 g and had grossly appearing brown myocardium with minimal pericardial fat. There was a bifid cardiac apex with an approximately 2-cm long cleft separating the right and left ventricles (Figs. 1 and 2). The fossa ovalis was closed. The atria and ventricles were not dilated. All four cardiac valves appeared unremarkable, without any vegetation or thrombi. The coronary ostia and coronary sinus were in the normal positions. The coronary arteries were right-dominant and did not exhibit any atherosclerotic narrowing or myocardial bridging. The distal left anterior descending artery tracked over the left ventricle on the left side of the cleft. On histological sections, no significant pathologic abnormalities were noted, and the conduction system was microscopically normal. At the bifid apex, there was separation of the left and right ventricular myocardium by mature adipose tissue.
⁎ Corresponding author. Tel.: +1-310-825-5719; fax: +1-310-267-2058. E-mail address: [email protected] (A. Wu). 1054-8807/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.carpath.2013.06.003
Bifid cardiac apex is a rare and unique congenital anomaly not commonly seen in human hearts and only reported in a handful of case reports, a majority of them associated with other cardiac
Fig. 1. Bifid cardiac apex with cleft between right and left ventricles.
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A. Wu et al. / Cardiovascular Pathology 23 (2014) 59–60
anomalies. A bifid apex, however, is quite common in marine animals such as whales and manatees. Bifid apex is likely an abnormality that is not associated with sudden cardiac death and, as in our unique case, was an incidental finding not necessarily associated with any other cardiac malformation or anomalies. References [1] Teja K, Sturgill BC. Bifid cardiac apex. Am Heart J 1986;111:1004–5. [2] Sayin OA, Ugurlucan M, Dursun M, Ucar A, Tireli E. Bifid cardiac apex: a rare morphologic structure. J Thorac Cardiovasc Surg 2006;131:474–5. [3] Victor S, Nayak VM. Bifid cardiac apex and right atrioventricular cleft. AustralAs J Cardiac Thorac Surg 1993;2(3):148–9. [4] Sedmera D, Misek I, Klima M, Thompson RP. Heart development in the spotted dolphin. Anat Rec A Discov Mol Cell Evol Biol 2003;273A:687–99.
Fig. 2. Closeup view of bifid cardiac apex with cleft between right and left ventricles.
Contents lists available at ScienceDirect
Cardiovascular Pathology
Images in Cardiovascular Pathology
Bifid cardiac apex in a 25-year-old male with sudden cardiac death Annie Wu a,⁎, Deborah Kay a, Michael C. Fishbein b a b
Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, UCLA Center for the Health Sciences 13-145, Los Angeles, CA 90095-1732, USA Department of Health, Office of the Chief Medical Examiner, Richmond, VA 23219, USA
a r t i c l e
i n f o
Article history: Received 23 January 2013 Received in revised form 26 June 2013 Accepted 26 June 2013 Keywords: Bifid cardiac apex Sudden cardiac death
a b s t r a c t Although a bifid cardiac apex is common in certain marine animals, it is an uncommon finding in humans. When present, bifid cardiac apex is usually associated with other congenital heart anomalies. We present a case of bifid cardiac apex that was an incidental finding in a 25-year-old male with sudden cardiac death from combined drug toxicity. On gross examination, there was a bifid cardiac apex with a 2-cm long cleft. There were no other significant gross or microscopic abnormalities. This case represents the very rare occurrence of a bifid cardiac apex as an isolated cardiac anomaly. © 2014 Elsevier Inc. All rights reserved.
The bifid cardiac apex is a rare entity that in humans has only been reported in cases with other congenital cardiac defects present as well [1–3]. Bifid apex is commonly found in marine mammals and is postulated to be characteristic of certain species such as the sperm whale and Florida manatee [4]. In human embryonic development, a cardiac notch indicating the site of the developing interventricular septum is usually seen between the fifth and eighth week of gestational age [1]. This notch disappears by the 11th week of gestation, and its postnatal persistence is likely the precursor to a bifid cardiac apex [1]. We have encountered a case where a bifid cardiac apex was an incidental discovery without any other cardiac anomalies. The heart was of a 25-year-old African-American male with sudden death from a combined methadone and alprazolam toxicity. The patient was 66.5 in. tall and weighed 132 lb. No other clinical history of the decedent was known at the time of examination. The heart weighed 305 g and had grossly appearing brown myocardium with minimal pericardial fat. There was a bifid cardiac apex with an approximately 2-cm long cleft separating the right and left ventricles (Figs. 1 and 2). The fossa ovalis was closed. The atria and ventricles were not dilated. All four cardiac valves appeared unremarkable, without any vegetation or thrombi. The coronary ostia and coronary sinus were in the normal positions. The coronary arteries were right-dominant and did not exhibit any atherosclerotic narrowing or myocardial bridging. The distal left anterior descending artery tracked over the left ventricle on the left side of the cleft. On histological sections, no significant pathologic abnormalities were noted, and the conduction system was microscopically normal. At the bifid apex, there was separation of the left and right ventricular myocardium by mature adipose tissue.
⁎ Corresponding author. Tel.: +1-310-825-5719; fax: +1-310-267-2058. E-mail address: [email protected] (A. Wu). 1054-8807/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.carpath.2013.06.003
Bifid cardiac apex is a rare and unique congenital anomaly not commonly seen in human hearts and only reported in a handful of case reports, a majority of them associated with other cardiac
Fig. 1. Bifid cardiac apex with cleft between right and left ventricles.
60
A. Wu et al. / Cardiovascular Pathology 23 (2014) 59–60
anomalies. A bifid apex, however, is quite common in marine animals such as whales and manatees. Bifid apex is likely an abnormality that is not associated with sudden cardiac death and, as in our unique case, was an incidental finding not necessarily associated with any other cardiac malformation or anomalies. References [1] Teja K, Sturgill BC. Bifid cardiac apex. Am Heart J 1986;111:1004–5. [2] Sayin OA, Ugurlucan M, Dursun M, Ucar A, Tireli E. Bifid cardiac apex: a rare morphologic structure. J Thorac Cardiovasc Surg 2006;131:474–5. [3] Victor S, Nayak VM. Bifid cardiac apex and right atrioventricular cleft. AustralAs J Cardiac Thorac Surg 1993;2(3):148–9. [4] Sedmera D, Misek I, Klima M, Thompson RP. Heart development in the spotted dolphin. Anat Rec A Discov Mol Cell Evol Biol 2003;273A:687–99.
Fig. 2. Closeup view of bifid cardiac apex with cleft between right and left ventricles.