Cardiovascular abnormalities in children: a ten-year forensic pathologic study

In order to obtain information on types, incidence, and significance of cardiovascular abnormalities in children, a total of 104 consecutive medicolegal autopsies of children aged 8 days to 16 years during a 10-year period from May 1974 to April 1984 were studied. Extensive histological examination of the hearts was performed in 92 out of 104 cases and complemented with chemical and microbiological analyses. In the natural death group consisting of 53 children, 26 (49%) showed abnormalities: 7 (13%) malformations, 11 (21%) cardiomyopathies, 5 (9%) idiopathic subaortic hypertrophy, and 3 (7%) a heart weight only 50% of the expected weight. In the violent death ("control") group, abnormalities were found in 8 of 39 cases (21%), all of which were cardiomyopathy. Only 5 of 34 cardiovascular abnormalities (every 7th case), all complex malformations, were clinically recognized. In 14 (15%) of the total 92 examined cases the cardiovascular abnormality was the only apparent cause of death, and in 12 (13%) a contributing cause of sudden unexpected natural death, while in 3 (3%) it was related to a fatal accidental injury. In 5 (13%) of the 39 cases of violent death, cardiomyopathy was an incidental finding without any connection to the circumstances or cause of death. The causes of cardiovascular abnormalities were associated with bacterial and viral infections, respiratory disorders, phenytoin sensitivity, or were unknown. Because of the differences in diagnostic criteria employed by previous investigators, it cannot be determined whether the incidence of the cardiovascular abnormalities and sudden cardiac death in children found in this material was higher than in other studies.