Pathology of the heart and conduction system in a case of sudden death dueto a cardiac fibroma in a 6-month-old child

A 6-month-old female infant considered to be in good health died suddenly a nd unexpectedly. Postmortem examination was requested, with clinical diagno sis of sudden infant death syndrome. Gross examination revealed, however, t he presence of a cardiac Mass 4.5 X 4 X 3.5 cm in diameter. Histological ex amination of the heart confirmed the presence of a cardiac fibroma. In the present case, the sudden death could have been due to the left ventricular outflow obstruction, as much as to conductive disturbances caused by overst retching and compression of the atrioventricular node and of the bundle bra nches. Hemodynamic and conductive abnormalities are presumed to have provok ed bradycardia degenerating into ventricular fibrillation and sudden death. Necroscopy studies of sudden death should always include histological exam ination of the cardiac conduction system but seldom do. (C) 1999 by Elsevie r Science Inc.