Fatal Acute Myocardial Infarction With Normal Epicardial Coronary Arteries Shortly Following COVID-19 Vaccination.

Myocarditis and acute myocardial infarction (AMI) have been reported after COVID-19 messenger ribonucleic acid vaccination. Nearly all reported patients with myocarditis or AMI after COVID-19 vaccination have survived and become asymptomatic. Described herein is a previously healthy man who developed severe heart decompensation shortly after receiving a COVID-19 vaccination and died approximately 40 hours later. An autopsy disclosed massive AMI.

Massively Hypertrophied Right-Sided Heart with Hypoplastic Left-Sided Heart in a Neonate (A Rare Type of Hypertrophic Cardiomyopathy).

Described herein is a newborn boy with likely right-sided hypertrophic cardiomyopathy (HC), who survived for 18 hours after birth. At necropsy, he had a severely thickened right ventricular free wall, ventricular septum, right atrial wall and a hypoplastic left-sided heart. There was a large fossa ovale type atrial septal defect and also a patent ductus arteriosus. During peak systole, the right ventricular outflow tract was obstructed, and its contents were pushed into the thick-walled right atrium, then rapidly into the thin-walled left atrium via a large fossa ovale atrial septal defect. The contents were then pushed into the thin-walled left ventricle and finally into the small ascending aorta and into the lungs via a large patent ductus arteriosus. We were unable to find a similar published case.

Fatal mitral stenosis secondary to massive mitral annular calcium.

Described herein are two patients who developed fatal acute heart failure due to mitral stenosis (MS) secondary to massive mitral annular calcium (MAC). This mechanism causing MS is rather unusual, but, nevertheless, it is probably the most common cause of MS today in Native Americans. Operative intervention for MS secondary to MAC is, as shown previously, hazardous and too frequently fatal.

Methamphetamine Injection Into Face Causing Fatal Cavernous Sinus Thrombosis.

ABSTRACT: Cavernous sinus thrombosis is a rare and often fatal condition, usually associated with infections in the head and neck region. Clinical presentation includes fever, headache, and periorbital swelling. Mortality can be high; however, prompt treatment can reduce the probability of death. We present a case of a cavernous sinus thrombosis associated with methamphetamine injection into the face.

Unsuitability of sump tubes for delivery of enteral nutrition and medications to intensive care unit patients.

16 Fr Salem Sump™ tubes have special features to facilitate suction drainage of the stomach, including a second lumen for air venting. These tubes are also commonly used to deliver enteral nutrition and medications to intensive care unit (ICU) patients, but we found no previous research to justify this practice. Because of the unused air vent, these tubes have a large external diameter and a small bore infusion channel (no larger than that of a single lumen 12 Fr feeding tube). The causes of 16 Fr Salem Sump tube obstructions in 17 ICU patients included clogged medications (8 cases) and precipitation of feeding formula (7 cases), each of which would be promoted by a narrow bore. Because of multiple drainage holes at their distal end, these tubes cannot be thoroughly cleansed by standard water flushing; moreover, their drainage holes mandate a deeper length of tube insertion beyond the gastroesophageal junction, which increases the likelihood of intestinal or pulmonary perforation. For these reasons, we conclude that 16 Fr Salem Sump tubes are inferior to standard feeding tubes for delivery of enteral nutrition and medications to patients in medical ICUs.

Papillary fibroelastoma in the left ventricle.

We present a 61-year-old woman with a recent transient ischemic attack who presented with presyncope and was ultimately found to have a papillary fibroelastoma at the apex of her left ventricle. She underwent minimally invasive excision of the tumor.

Isolated mitral valve endocarditis with ring abscess and pericarditis in end-stage renal disease.

Described herein is a 68-year-old man with end-stage renal disease on hemodialysis who was found to have methicillin-sensitive Staphylococcus aureus endocarditis with an associated ring abscess that extended into the left atrioventricular sulcus and ruptured into the pericardial space causing pericardial effusion. In contrast to the frequency of infective endocarditis involving the aortic valve, ring abscess associated with infection of the mitral valve is uncommon.

Rapidly progressive fatal hypoxia in a young woman.

We present a rare cause of pulmonary arterial hypertension in a 29-year-old woman with rapidly progressive and fatal hypoxia. Subsequent workup revealed classic radiological findings and pathologic confirmation of pulmonary veno-occlusive disease.

Acute myocardial infarction secondary to mucormycosis after lung transplantation.

We present a case of a 57-year-old man who underwent bilateral lung transplantation for idiopathic pulmonary fibrosis. His immediately post-operative course was complicated by fever and cardiac arrest. Despite supportive care and broad-spectrum antibiotics, he experienced continued clinical decline. Autopsy results indicated angioinvasive mucormycosis and coronary arteritis resulting in acute myocardial infarction as the cause of death.

Relation of the quantity of coronary calcium to the quantity of aortic calcium determined from radiographs at necropsy.

Described herein are radiographs of the heart and aorta at necropsy after "cleaning" these structures of extraneous tissue. As a consequence, the quantity of calcium is far more discernible than by computed tomography or magnetic resonance or ultrasonic imaging during life or before extraneous tissues are removed at necropsy. We illustrate these radiographic images at necropsy in three patients to show that the relative amount of calcific deposits in the coronary arteries and aorta may be subjectively similar or one of these structures may have far more calcium in the arterial walls than the other. The reasons for these differences are unclear.

Examining Hearts Containing Left Ventricular Assist Devices at Necropsy.

There are no publications describing hearts at necropsy containing left ventricular assist devices (LVADs). The purpose was to study the relation of the LVAD cannula to the left ventricular (LV) cavity and wall. We studied the hearts at necropsy of 15 adults who had an LVAD inserted from 4 to 1,423 days (median 60) earlier. In 13 patients, the cannula had been inserted at an angle to the major longitudinal axis of the LV chamber, and in 11 patients, the orifice margin of the cannulas contacted the LV mural endocardium. In 3 patients, the LVAD cannula was inserted into the posterior wall, and, in another into the anterior wall. In the remaining 11 patients, the cannula had been inserted into the LV apex. Despite the insertion of the cannulas into the LV apex, the direction of the insertion was not into the longitudinal axis of the LV cavity in 9 patients. These unusual insertions in some patients may have altered flow into the orifice of the cannula; in others, based on their long postoperative survival, physiologic consequences were almost certainly absent. The presence of considerable quantities of subepicardial adipose tissue and pericardial adhesions from previous cardiac procedures (mainly coronary bypass) potentially interfered with achieving proper alignment of the LVAD cannula during its insertion. Misalignment of the cannulas of the LVAD in the LV cavity appears to be rather frequent.

Potential cardiac consequences of thrombocytopenia and thrombocytosis.

This report illustrates the heart in three patients with cardiac hemorrhages associated with extreme thrombocytopenia, and the hearts in three patients with rocks speculated to result at least in part from organization of thrombi possibly related to thrombocytosis in one or more cardiac chambers.

Deaths associated with insertion of nasogastric tubes for enteral nutrition in the medical intensive care unit: Clinical and autopsy findings.

It is generally assumed that blind insertion of nasogastric tubes for enteral nutrition in patients admitted to medical intensive care units is safe; that is, does not result in life-threatening injury. If death occurs in temporal association with insertion of a nasogastric tube, caregivers typically attribute it to underlying diseases, with little or no consideration of iatrogenic death due to tube insertion. The clinical and autopsy results in three recent cases at Baylor University Medical Center challenge the validity of these notions.

Morphologic Findings in Donor (Transplanted) Hearts at Necropsy Early and Late After Orthotopic Heart Transplantation.

Little necropsy information is available on donor hearts in place in recipients for varying periods. Necropsy studies were performed in 79 patients who had survived from 1 day to 17 years after orthotopic heart transplantation (OHT). At OHT, the 79 patients ranged in age from 3 to 70 years (mean 51), and at death, from 20 to 76 years (mean 54). The native hearts tended to be larger than the donor hearts in the 22 patients surviving ≤60 days and the donor hearts tended to be larger in the 57 patients surviving >60 days, suggesting that the donor hearts increased in weight with time. Cardiac adiposity increased with time. Grossly visible myocardial lesions were seen in 24 (30%) of the 79 cases: necrosis only in 20; fibrosis only in 2, and both in 2. One or more epicardial coronary arteries were narrowed >75% in cross-sectional area in 25 (32%), 1 of whom was in the group surviving ≤60 days. The right ventricular cavity was dilated in 73 cases (92%) and the left ventricular cavity in 39 cases. Evidence of graft rejection (lymphocytic infiltrates) was found in 50 patients (63%); in 8 (36%) of the 22 patients surviving ≤60 days, and in 42 (74%) of the 57 surviving >60 days. The lymphocytic infiltrates were largest in the subepicardial adipose tissue, next in myocardium, and least in endocardium. The quantity of the cellular infiltrates varied considerably among the patients. In conclusion, with time, the donor hearts tended to increase in weight, in the quantity of adipose tissue, in the amounts of coronary narrowing, in the frequency of ventricular cavity dilatation (particularly the right ventricle), and in the frequency of lymphocytic infiltrates (evidence of rejection).

Combined atresia of one left-sided and one right-sided cardiac valve in a premature newborn.

Described herein is the heart of a 2-day-old newborn, the product of a 25-week gestation, with atresia of two cardiac valves, one on the right side and one on the left side, apparently a previously undescribed entity.

Full Development of Consequences of Congenital Pulmonic Stenosis in Eighty-Four Years.

Described herein is an 84-year-old woman, the oldest reported, with severe pulmonic stenosis who underwent a highly successful pulmonic valvotomy at age 77 and highly unsuccessfully attempted percutaneous pulmonic valve implantation at age 84. During the 84 years she developed nearly all clinical and morphologic consequences of pulmonic stenosis, including heavy calcification of the pulmonic valve, heavy calcification of the tricuspid valve annulus, severe right ventricular wall thickening without ventricular cavity dilation, aneurysm of the pulmonary truck, multiple focal ventricular wall scars without narrowing of the epicardial coronary arteries, wall thickening and luminal narrowing of the intramural coronary arteries, and extremely low 12-lead QRS electrocardiographic voltage.

Case report: whole exome sequencing of primary cardiac angiosarcoma highlights potential for targeted therapies.

BACKGROUND: Primary cardiac angiosarcomas are rare, but they are the most aggressive type of primary cardiac neoplasms. When patients do present, it is with advanced pulmonary and/or cardiac symptoms. Therefore, many times the correct diagnosis is not made at the time of initial presentation. These patients have metastatic disease and the vast majority of these patients die within a few months after diagnosis. Currently the treatment choices are limited and there are no targeted therapies available. CASE PRESENTATION: A 56-year-old male presented with shortness of breath, night sweats, and productive cough for a month. Workup revealed pericardial effusion and multiple bilateral pulmonary nodules suspicious for metastatic disease. Transthoracic echocardiogram showed a large pericardial effusion and a large mass in the base of the right atrium. Results of biopsy of bilateral lung nodules established a diagnosis of primary cardiac angiosarcoma. Aggressive pulmonary disease caused rapid deterioration; the patient went on hospice and subsequently died. Whole exome sequencing of the patient's postmortem tumor revealed a novel KDR (G681R) mutation, and focal high-level amplification at chromosome 1q encompassing MDM4, a negative regulator of TP53. CONCLUSION: Mutations in KDR have been reported previously in angiosarcomas. Previous studies also demonstrated that KDR mutants with constitutive KDR activation could be inhibited with specific KDR inhibitors in vitro. Thus, patients harboring activating KDR mutations could be candidates for treatment with KDR-specific inhibitors.

Acute Aortic Dissection With Intussusception of the Partition Between the True and False Channels Leading to Near Total Aortic Occlusion (True Aortic Stenosis).

Described herein are 2 patients with fatal acute aortic dissection resulting in a circumferential intimal-medial tear causing the partition between the true and false channels to roll up and propagate forward as an intra-aortic intussusception (a receiving within).

Causes of Death and Heart Weights in Adults at Necropsy in a Tertiary Texas Hospital, 2013-2015.

The causes of death and heart weights at death appear to be quite different in the USA today than in the first few decades of the last century. We determined the causes of death and heart weights at necropsy in 231 adults and compared the heart weights to those reported in several studies in the first half of the 20th century. Of the 231 patients, 91 (39%) died of a cardiovascular (CV) condition, and 140 (61%), of a non-CV condition. Of the 91 fatal CV disease cases, 48 had fatal coronary artery disease (CAD); of the remaining 183 cases without fatal CAD, 25 had narrowing >75% of 1 or more major epicardial coronary arteries. Thus, 73 of the 231 (32%) patients at necropsy had severe CAD. Comparison between the fatal CV and fatal non-CV cases disclosed variable age (mean 64 years vs mean 57 years) and heart weight (529 g vs 449 g) to be significantly different. Heart weight was found to be the only significantly variable between men and women. Comparison of the heart weights in this study to those recorded as "normal" hearts 75 to 115 years earlier showed that today's "average" heart is much larger than those reported earlier. In contrast to the earlier studies, heart weight presently appears to increase with age and with an increase in body mass index. In conclusion, early studies in heart weight did not take into account today's longer survival and therefore a high prevalence of systemic hypertension, diabetes mellitus, obesity (and cardiac adiposity), and the presence of atherosclerotic CAD. Additionally, the cause of death (CV vs non-CV) was rarely considered in the early studies of heart weight.

Origin of the left subclavian artery as the first branch and origin of the right subclavian artery as the fourth branch of the aortic arch with crisscrossing posterior to the common carotid arteries.

We describe an aortic arch anomaly consisting of the origin of the left subclavian artery as the fourth branch and the right subclavian artery as the first branch off the aortic arch with crisscrossing of these two arteries anterior to the trachea without clinical consequences. This anomaly, to our knowledge, has not been reported previously.