Case 755 -- An 11 year old female who collapsed during out-patient clinic visit

Contributed by Arivarasan Karunamurthy, MD.


The patient is an 11 year old female who collapsed during an out patient clinic visit. Her past history included a diagnosis of rheumatic heart disease with valvular abnormalities made 5 years ago and she is on regular penicillin prophylaxis along with anti-coagulant and anti-failure treatment. Patient died within few hours and autopsy was performed.


All the organs except for heart and kidney were unremarkable. Right Kidney showed a 1.5 cm infarct on the anterior surface. The remarkable features in the heart were massive cardiomegaly and spongy appearance of left ventricle as that of right ventricle

Left ventricle also showed increased trabeculations with deep intertrabecular recesses affecting the apical and mid portions of left ventricle. The deep intertrabecular recesses were communicating. (Figure 1)

The proportion of compact to trabecular portion of left ventricle is markedly decreased. The ratio of noncompacted to compacted left ventricle was 2.2 (Figure 2) Features of chronic mitral regurgitation such as thickening and marked rounding of free margins of anterior /posterior leaflets were also noted. There were decreased number of chordae; few with direct anchorage to endocardium along with ill-formed papillary muscles (Figure 3). The microscopic findings substantiated the gross pathological features. (Figure 4)


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