Sudden unexpected infantile death due to undiagnosed ventricular septal defect-associated heart failure with single coronary artery

  • Shogo Kasuda
  • Risa Kudo
  • Katsuya Yuui
  • Takeshi Kondo
  • Katsuhiko Hatake
Images in Forensics


Ventricular septal defect (VSD) generally has a good prognosis unless complicated by heart failure (HF). We report a case of sudden infant death because of clinically undiagnosed VSD in a seemingly healthy 16-day-old boy. Although a cardiac murmur was auscultated at birth, detailed clinical examination was not performed. Medicolegal autopsy revealed a perimembranous large VSD with a single coronary artery. The infant was diagnosed to have had HF based on the increased weight of the heart and extremely high serum brain natriuretic peptide levels. Histological examination revealed the degeneration of cardiomyocytes. The large VSD was thought to be the major cause of HF, although single coronary artery–associated cardiomyopathy might have also partially contributed to it. The decline in the physiological neonatal pulmonary resistance, which occurs over the first 1 or 2 weeks following birth, led to the acute progression of HF, resulting in circulatory collapse and sudden death. Detailed clinical examination should be performed for neonates with cardiac murmur to prevent avoidable death.


Ventricular septal defect Single coronary artery Heart failure Dilated cardiomyopathy Sudden death 



We would like to thank Ms. Ikuko Terazawa for her technical assistance in postmortem examinations.

Compliance with ethical standards

Conflict of interest

None of the authors have conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

The article does not contain any studies with human participants requesting their informed consent.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Legal MedicineNara Medical UniversityNaraJapan
  2. 2.Division of Legal Medicine, Department of Community Medicine and Social Healthcare ScienceKobe University Graduate School of MedicineKobeJapan

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