Myocardial inflammation, cellular death, and viral detection in sudden infant death caused by SIDS, suffocation, or myocarditis.

The significance of minor myocardial inflammatory infiltrates and viral detection in SIDS is controversial. We retrospectively compared the demographic profiles, myocardial inflammation, cardiomyocyte necrosis, and myocardial virus detection in infants who died of SIDS in a safe sleep environment, accidental suffocation, or myocarditis. Formalin-fixed, paraffin-embedded myocardial sections were semiquantitatively assessed for CD3 lymphocytes and CD68 macrophages using immunohistochemistry and for cardiomyocyte cell death in H&E-stained sections. Enteroviruses and adenoviruses were searched for using PCR technology. The means of lymphocytes, macrophages, and necrotic cardiomyocytes were not statistically different in SIDS and suffocation cases. Enterovirus, not otherwise specified, was detected in one suffocation case and was the only virus detected in the three groups. Very mild myocardial lymphocyte and macrophage infiltration and scattered necrotic cardiomyocytes in SIDS are not pathologic, but may occur after the developing heart is exposed to environmental pathogens, including viruses.

Adverse impact of vascular stent "mass effect" on airways.

OBJECTIVES: To report our experience with bronchial compression secondary to vascular stent implantation within the mediastinum of patients with congenital heart disease. BACKGROUND: Stents are routinely used to correct native and postsurgical vessel stenoses. However, the "mass effect" of stents on adjacent structures within the chest has not been consistently appreciated nor evaluated. METHODS: A retrospective review of patients who had stent implantation and subsequent computerized tomographic angiography (CTA) at Rady Children's Hospital was performed. RESULTS: From August 2005 to November 2007, 147 stents were implanted to correct vessel stenoses within the chests of 120 patients. Among these 120 patients, 21 had CT angiograms performed after stent implantation. Clinical indications for poststent CT imaging included inability to wean from ventilator support, significant coughing episodes, continued hypoxia, and follow-up study after complex repairs. Six of the twenty one patients (29%) had adverse mass effects from stents causing compression of adjacent bronchial structures. Two of the six patients expired. One patient required a tracheostomy, two patients were slow to wean from the ventilator, while one was clinically asymptomatic. Five of the six patients had had an aortic arch anomaly with subsequent arch reconstruction or hybrid intervention. CONCLUSIONS: Stent implantation in vascular structures within the chest may have adverse mass effects on adjacent bronchial structures. Clinical sequelae may range from silent to catastrophic. Pre-and/or poststent implantation imaging of vascular structures and airways should be considered in selected patients.