Strajina Veljko, Živković Vladimir, Nikolić Slobodan
Institute of Forensic Medicine, University of Belgrade- School of Medicine, 11000, Belgrade, Serbia.
J Forensic Sci. 2013 Mar;58(2):544-7. doi: 10.1111/1556-4029.12064. Epub 2013 Mar 12.
Anomaly in the anterior papillary muscle (APM) is known to cause left ventricle outflow tract (LVOT) obstruction, and this rare congenital condition could be a cause of sudden cardiac death. This anomaly and its hemodynamic effects is similar to valvular heart disease. In our two described cases, in which cause of death was, respectively, hypertrophic cardiomyopathy and suicide by hanging, the cephalad portion of the left APM was inserted directly into the ventricular surface of the anterior mitral leaflet and chordae tendineae were absent in the area of the direct anomalous muscle insertion; the aberrant papillary muscle was very large and showed an exaggerated anterior displacement within the left ventricular cavity. The described anomaly is a cause of LVOT obstruction. This condition is considered to be rare, although incidence estimates do not exist. In the absence of other possible causes, this finding may indicate arrhythmia as being the immediate cause of death.
已知前乳头肌（APM）异常会导致左心室流出道（LVOT）梗阻，这种罕见的先天性疾病可能是心源性猝死的原因。这种异常及其血流动力学效应与瓣膜性心脏病相似。在我们描述的两例病例中，死亡原因分别是肥厚型心肌病和上吊自杀，左APM的头侧部分直接插入二尖瓣前叶的心室表面，在直接异常肌肉插入区域无腱索；异常乳头肌非常大，在左心室内显示出过度的向前移位。所描述的异常是LVOT梗阻的一个原因。尽管不存在发病率估计，但这种情况被认为是罕见的。在没有其他可能原因的情况下，这一发现可能表明心律失常是直接死因。
