Marchesi Matteo, Boracchi Michele, Gentile Guendalina, Maghin Francesca, Zoja Riccardo
Responsabile USS Medicina Legale, Azienda SocioSanitaria Papa Giovanni XXIII, Ospedale di Bergamo, Italy.
Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy.
Leg Med (Tokyo). 2017 Sep;28:6-9. doi: 10.1016/j.legalmed.2017.07.003. Epub 2017 Jul 12.
Congenital diverticula of the left ventricle, very rare malformations, are determined by an abnormal embryonic development of the ventricular wall and can be isolated or associated to other cardiac anomalies. In most of the cases, these pathologies are not symptomatic and in some patients can be associated to ventricular arrhythmia, cardiac rupture with tamponade and sudden death. Authors are presenting the case of a sudden death in an 8-weeks-old newborn due to rupture of a cardiac congenital diverticulum of the left ventricle, discovered only at the moment of the autopsic examination. The parents of the victim pressed charges against the medical staff that was appointed to the cares, blaming them with malpractice. The missed diagnosis of a cardiac congenital diverticulum of the left ventricle, a rare pathology, reflects the trickiness of the medical management that can lead to medico-legal controversies and, even though such rare conditions must be always taken into consideration when investigating possible dysfunction causing the death, diagnostic difficulties, in the case in exam, justify the missed diagnosis intra-vitam of cardiac ventricular diverticulum.
左心室先天性憩室是非常罕见的畸形，由心室壁的异常胚胎发育所决定，可单独存在或与其他心脏异常相关。在大多数情况下，这些病变没有症状，而在一些患者中可能与室性心律失常、心脏破裂伴心包填塞及猝死有关。作者报告了一例8周龄新生儿因左心室先天性心脏憩室破裂而猝死的病例，该憩室仅在尸检时才被发现。受害者的父母对负责护理的医务人员提出指控，指责他们存在医疗过失。左心室先天性心脏憩室这种罕见病变的漏诊，反映了医疗管理的棘手性，这可能导致医疗法律纠纷，并且尽管在调查可能导致死亡的功能障碍时必须始终考虑到这种罕见情况，但就本案而言，诊断困难证明生前漏诊心室憩室是合理的。
