Cardiac valve hemangioma in two cases of sudden infant death

SIDS (the sudden death of an infant <1 year of age) is a specific subcategory of Sudden Unexpected Infant Death (SUID). In Italy, managing SUID should be ruled by the National Protocol (7th October, 2014) however autopsies are not performed in all cases of sudden unexpected infant deaths. Autopsies should be performed, properly and in a timely manner in every SUID case since representing a crucial point in monitoring the phenomenon, providing an important contribution to research, and supporting bereaved families. The complexity of diagnosing SUID cases necessitates a well-structured organization to ensure a thorough approach. Many fatalities can be attributed to cardiovascular abnormalities identified through both macro and microscopic examinations, such as cardiomyopathies, congenital heart defects, coronary artery anomalies, and myocarditis. However, it is important to note that even after comprehensive autopsies and investigations, approximately one-third of these deaths remain unexplained. Cardiac hemangiomas (CH) are defined by the presence of benign proliferative endothelial cells that line blood vessels, accompanied by enhanced vascularization. Microscopically, these tumors exhibit vascular channels that are lined with endothelial cells displaying moderate pleomorphism, occasionally featuring atypical nuclei and localized tuft formations. Limited case reports indicate that CH can infiltrate the heart's conductive tissue, raising concerns about their clinical significance due to the potential for severe complications, including syncope, stroke, and even sudden death. The authors present two cases of sudden infant death in two see-mingly healthy infants, during which cardiac valve hemangiomas were identified in post-mortem examinations. Expanding awareness of such cases can significantly aid in the diagnosis of this condition, whether during the antenatal phase or at autopsy, thereby helping to mitigate the risk of recurrence in future pregnancies, which is notably heightened.