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Anomalous anterior papillary muscle as an autopsy finding in two cases
Veljko Strajina1, Vladimir Živković, Slobodan Nikolić
1Institute of Forensic Medicine, University of Belgrade- School of Medicine, 11000, Belgrade, Serbia.
Abstract:
Anomaly in the anterior papillary muscle (APM) is known to cause left ventricle outflow tract (LVOT) obstruction, and this rare congenital condition could be a cause of sudden cardiac death. This anomaly and its hemodynamic effects is similar to valvular heart disease. In our two described cases, in which cause of death was, respectively, hypertrophic cardiomyopathy and suicide by hanging, the cephalad portion of the left APM was inserted directly into the ventricular surface of the anterior mitral leaflet and chordae tendineae were absent in the area of the direct anomalous muscle insertion; the aberrant papillary muscle was very large and showed an exaggerated anterior displacement within the left ventricular cavity. The described anomaly is a cause of LVOT obstruction. This condition is considered to be rare, although incidence estimates do not exist. In the absence of other possible causes, this finding may indicate arrhythmia as being the immediate cause of death.
Insights
An abnormal anterior papillary muscle (APM) can obstruct the left ventricle outflow tract (LVOT), potentially causing sudden cardiac death. This rare congenital anomaly mimics valvular heart disease and may indicate arrhythmia as the cause of death.
Area of Science:
- Cardiology
- Pathology
- Congenital Heart Disease
Background:
- Anterior papillary muscle (APM) anomalies are rare congenital conditions.
- These anomalies can lead to left ventricle outflow tract (LVOT) obstruction.
- The hemodynamic effects resemble valvular heart disease.
Observation:
- Two cases presented with anomalous APM insertion directly into the anterior mitral leaflet.
- Chordae tendineae were absent at the anomalous muscle insertion site.
- The aberrant APM was large and displaced anteriorly within the left ventricle.
Findings:
- The described APM anomaly is a cause of LVOT obstruction.
- This condition is rare, with no current incidence estimates.
- It can mimic hypertrophic cardiomyopathy or be a factor in sudden cardiac death.
Implications:
- Anomalous APM should be considered in cases of unexplained LVOT obstruction.
- In the absence of other causes, this anomaly may suggest arrhythmia as the immediate cause of death.
- Further research is needed to determine the incidence and clinical significance of this rare anomaly.
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