Myocardial necrosis and infarction in newborns and infants

This study aimed to investigate the incidence, and underlying associations, of myocardial necrosis occurring in infants undergoing autopsy. An autopsy database containing anonymized details of all infant autopsies conducted at Great Ormond Street Hospital between January 1996 and December 2010 was searched to identify all infants with myocardial necrosis. The characteristics of the necrosis and any underlying associations were reviewed. Myocardial necrosis was recorded in 187 autopsies out of a total of 1,637 (11.4 %), and was localized to the papillary muscles, subendocardial region, or trabeculae in 50.8 % of cases. The most common associations were congenital heart disease, perinatal asphyxia, coronary artery abnormalities, or sepsis. Three cases of apparently idiopathic myocardial infarction were identified and are described in detail. Myocardial necrosis is relatively common in infants who die and undergo autopsy, and is most commonly associated with congenital heart disease and perinatal asphyxia. Myocardial infarction can occur in infancy in the absence of any apparent underlying cause: the etiology of these cases is unclear.