Anatomical Variant or Pathological Anomaly? A Case Report of an Asymptomatic Cardiac Apical Cleft

Congenital cardiac malformations are the most common birth defects, with a global prevalence of approximately 8 per 1000 live births. While most are symptomatic, a small subset of structural variants can remain clinically silent. We report a rare case of a deep apical cleft, an incidental and benign post-mortem finding that must be differentiated from clinically significant pathologies such as left ventricular non-compaction cardiomyopathy, ventricular diverticula, or aneurysms.

During an autopsy of a 38-year-old African male, deceased from a road traffic accident, a deep, V-shaped cleft was discovered at the anterior cardiac apex, measuring 4.2 cm in length and 1.5 cm in depth. The heart was otherwise grossly normal, with no evidence of hypertrophy, septal defects, or vascular anomalies. The patient had no prior history of cardiac symptoms.

The isolated cardiac apical cleft in this asymptomatic adult is a rare anatomical variant, likely a benign developmental anomaly. This case highlights the critical importance of meticulous post-mortem examination and anatomical knowledge to distinguish between a harmless congenital variant and a pathological condition, serving as a valuable educational case for forensic pathologists and cardiac specialists.