Congenital Heart Diseases among 8,500 Consecutive Autopsy Cases in the Aged

¹⁾Division of Medicine, Kasumigaseki Bldg. Clinic, and ²⁾Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan

Abstract

Among 8,500 consecutive autopsies of elderly adults performed at Tokyo Metropolitan Geriatric Hospital during the past 37 years (from 1967 to 2004), congenital heart disease (CHD) was found in 93 cases (1.1% of total autopsy cases: 43 men, 50 women; mean age 79.0 yrs.). Among those 93, ASD was the most common, found in 28 cases (30.1%; 15 men, 13 women: mean 81.4 yrs.), followed by 17 of AS (due to congenital bicuspid aortic valve), 16 of MR (induced by 1 of cleft mitral valve, 6 of abnormal chordae tendinea, and 9 of absent commissural chordae), 4 of ECD, VSD, PAPVR, and PDA respectively, 2 each of PS (1 supravalvular, 1 infravalvular), corrected TGA, TR, Ebstein’s anomaly, and one case each of IDPA, DSS, ruptured Valsalva sinus aneurysm, hypo LV, dextrocardia, levocardia, partial defect of RV and double chamber RV. Among the other congenital cardiac anomalies, there were 15 cases of spontaneous closure of VSD, 29 of bicuspid aortic valve, 35 quadricuspid pulmonary valve cases, 49 high take-off of the coronary orifice, 8 cases of coronary AV fistula and 64 coronary anomalies (single CA in 5, RCA from LCS in 12, LCA from NCS in 2, LCA from RCS in 2, LCX from RCS in 4, LCX from RCA in 2, absent LMT in 11, and others in 26), absent commissural chordae of MV in 26, and 50 cases of direct insertion of papillary muscle into the anterior mitral leaflet.
In conclusion, among 8,500 consecutive autopsies of the elderly, the incidence of CHD was 1.1% (93/8,500), and ASD (secundum type) was the most common CHD at 30.1% (28/93). In the other congenital cardiac abnormalities, various kinds of coronary anomaly were not infrequent.