A 5-month-old girl, 15 days old, second daughter with a healthy 6-year-old brother, was admitted to the hospital derived by her pediatrician by slow somatometry (Percentile 3), BMI of 14 kg/m.
The initial examination showed malnutrition, acrocia increased with crying, tachycardia, slight dyspnea and pansystolic murmur II-III in several locations at auscultation.
She was diagnosed with congenital heart disease: transposition of the great vessels with intact septum (TGV with SI), and underwent urgent surgery.
First, enlargement was performed by catheterization of the foramen ovale, followed by subclavian-pulmonary fistula and banding in the pulmonary artery.
The postoperative evolution was unfavourable, dying in the pediatric ICU 8 days after admission.
Parents requested a medico-legal autopsy in case of suspicion of poor medical performance.
Autopsy:
a) Exterrane
Weight of 6440 g, height of 64 cm (BMI: 15.6 kg/m2), perimeter of 39.5 cm, thoracic perimeter of 45 cm and abdominal perimeter of 42 cm.
(b) Internal
620 g brain with extensive ischemic stroke at left parieto-occipital level corresponding to the territory of irrigation of the middle cerebral artery.
1.
We proceeded to the extraction and fixation of the cardiopulmonary block for later macroscopic examination, in which stood out the existence of a surgically intervened TGV presenting a banding in the pulmonary artery, a fistula between the right ventricle and ventricular enlargement.
He also presented an anomaly of the exit of the coronary arteries, the presence of two coronary ostium that left the same sinus.
1.
Histological examination revealed pericarditis of the heart due to dystrophic calcification at the myocardial level.
In the lungs the presence of hyaline membranes was observed as a sign of respiratory distress.
On the other hand, the encephalon showed signs of anoxic encephalopathy and recent parietal infarction.
1.
Thus, in the light of the macroscopic and microscopic results, it was determined that the cause of death was an ischemic cerebral infarction in a patient undergoing transposition of great arteries.
