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Granulomatous cardiomyopathy (GCM) is relatively uncommon in patients presenting with ventricular tachycardia (VT). Sarcoidosis and tuberculosis are the most common causes of GCM with VT. The aim of study was to evaluate their clinical characteristics and the long-term outcomes.We retrospectively analyzed patients from March 2004 to January 2020, presenting with VT and subsequently diagnosed to have GCM. Patients were divided into three groups (sarcoid, tuberculosis and indeterminate) based on serologic tests, imaging and histopathology. The response to anti-arrhythmic and disease specific therapy on long-term follow-up were analyzed.There were 52 patients, comprising 27 males and 25 females, age 40 ± 10 years. The follow-up period was 5.9 ± 3.9 years. Sarcoidosis was diagnosed in 20 (38%); tuberculosis (TB) in 15(29%) and 17(33%) patients were indeterminate. Left ventricular ejection fraction (LVEF) of the entire cohort was 0.45 ± 0.14. Erythrocyte Sedimentation Rate(ESR) was found to be significantly higher in TB(43.6 ± 18.4) patients vs sarcoid(18.9 ± 6.7)p 0.0001, but not the indeterminate group (36.2 ± 21.1), p = 0.3. Implantable Cardioverter Defibrillator (ICD) implantation was performed in 12/20(60%) patients in the sarcoid group, in 4/15(27%) patients in the TB group and in 10/17(59%) patients in the indeterminate group. At a mean follow-up of six years, VT recurrences were noted in 6, 2, and 7 patients in the sarcoid, TB and indeterminate groups respectively.Despite the advances in diagnostic modalities for tuberculosis and sarcoidosis, in real-world practice, almost one-third of the patients with VT and GCM have uncertain etiology. Long term outcomes of patients presenting with GCM and VT with mild left ventricle dysfunction treated appropriately seems favorable.

Involvement of both right and left heart chambers with infective endocarditis is extremely rare. In this case report, we aimed to present a rare case of Infective endocarditis (IE) in an intravenous & inhalational drug misuse involving both cardiac chambers with incidental pneumoconiosis.

Rheumatic heart disease, particularly rheumatic mitral stenosis and hemoglobinopathies, especially HbS can pose a problem in pregnancy. Though both these conditions have a high incidence and considerable geographic overlap in India, very few studies have reported these diseases occurring concurrently. This is a report of concurrent recently diagnosed rheumatic mitral stenosis and undiagnosed sickling hemoglobinopathy in a post-partum woman.

Background Balloon mitral valvotomy (BMV) is a well-established therapeutic modality for rheumatic mitral stenosis (RMS). However, there are chances of procedural failure and the more ominous post-procedural severe mitral regurgitation. There are only a few prospective studies, which have evaluated the pathogenic mechanisms for these major complications of BMV, especially in relation to the subvalvular apparatus (SVA) pathology. Methods All symptomatic patients of RMS suitable for BMV by echocardiographic criteria in a span of 1 year were selected. In addition to the standard echocardiographic assessment of RMS (Wilkins score and score by Padial et al.), a separate grading and scoring system was assigned to evaluate the severity of the SVA pathology. The SVA score was ‘I’, when none of the two SVAs had severe disease, ‘II’ when one of the two SVAs has severe disease, and ‘III’ when both SVAs had severe disease. With these scoring systems, the outcomes of BMV (successful procedure, failure, and post-procedural mitral regurgitation) were analyzed. Emergency valve replacement was performed depending on clinical situation, and in cases of replacement, the pathology of the excised mitral valves were compared with echocardiographic findings. Results Of the 356 BMVs performed in a year, 43 patients had adverse outcomes in the form of failed procedure (14 patients) and mitral regurgitation (29 patients). Forty-one among these had a SVA score of III. The sensitivity and specificity of the MR score was lesser than the SVA score (sensitivity 0.34 vs. 1.00, specificity 0.92 vs. 0.99, respectively). The mitral valvular morphology in 39 patients who underwent post-procedural valve replacements correlated well with echocardiography findings. Conclusion It is important to assess the degree of SVA pathology in the conventional echocardiographic assessment for RMS, as BMV would have adverse events when both SVAs were severely diseased.

Adult Pulmonary Langerhans Cell Histiocytosis (PLCH) is a rare interstitial lung disease which occurs almost exclusively in smokers. A marked male predominance was initially reported, but recent studies show both men and women are equally affected due to the increasing smoking habits in women. The natural history is variable with 25% of patients having asymptomatic disease while 10–20% progress rapidly to respiratory insufficiency and death. The diagnosis is not easily recognized by clinicians or pathologists. Awareness of the clinical presentation and classical HRCT findings helps in early diagnosis and management of this disease. We report a rare case of severe PLCH in a young non smoking female with a short history who progressed rapidly to respiratory failure and died.

The mitral-aortic intervalvular fibrosa is an avascular fibrous structure between the anterior mitral leaflet and the aortic annulus. Pseudoaneurysm formation of the mitral-aortic intervalvular fibrosa is a rare but known entity most commonly caused by infective endocarditis or valve surgery. We present a 29-year-old patient with a mitral-aortic intervalvular fibrosa pseudoaneurysm of no evident cause who was successfully managed surgically.

Lipoleiomyomas are benign mesenchymal tumours of smooth muscle and adipose tissue and uncommonly occur in the uterus. Here we report a case of uterine lipoleiomyoma that manifested purely as intravenous component and clinically presented as a large retroperitoneal mass with extension into inferior vena cava and right atrium. The connection of the mass to the corneal end of the uterus was noted only at surgery.

Acute myocardial infarction is responsible for a significant proportion of morbidity and mortality in patients with ischaemic heart disease. Apart from cardiogenic shock, important mechanical complications include myocardial rupture, mitral regurgitation, mural thrombosis, left ventricular true aneurysm and pericarditis. Such patients are likely to be older (more than 60 years of age), especially women with hypertension, single-vessel disease, first episode of transmural infarction, smaller area of infarction, and/or delayed thrombolytic therapy. The incidences of all these complications have significantly reduced due to availability of reperfusion techniques. Myocardial rupture includes rupture of the left ventricular free wall, interventricular septum or papillary muscles, which can occur within few hours or days after infarction and emergency surgery is indicated. Lateral displacement of papillary muscles due to post-infarctional left ventricular remodelling is the main factor for ischaemic mitral regurgitation; some patients would require mitral valve repair or replacement. Mural thrombosis results from an abnormal flow and local hypercoagulable state and requires thrombolytic therapy or even surgical excision. Post-infarctional fibrosis is also responsible for formation of ventricular apical aneurysms and depending on the clinical status, reconstructional surgery may be required. Dressler's syndrome is a rare occurrence of fibrinous pericarditis accompanied by constitutional symptoms, which responds to immunomodulation.

Introduction Intracardiac thrombi (ICT), more commonly encountered at autopsy, are well documented with underlying cardiovascular disease. Occurrence of ICT in systemic diseases without an intrinsic cardiac disorder is rare. The aim of this autopsy study was to highlight such an occurrence. Methods From 1996 to 2010, cases with ICT unrelated to primary cardiac disorders were selected at autopsy and analyzed. Clinical and investigational data were obtained from the medical records. The location, morphology, size, and histological appearance of the thrombi were noted. The thrombi were then classified on the basis of their location, nature, and histology (fresh and/or organized); this was correlated with the clinical setting. Results Among a total of 11,724 autopsies performed in 15 years, 276 patients (2.4%) had ICT. Of these, 45 patients (0.4%) had ICT that were unrelated to primary cardiac diseases. There were 25 men and 20 women with a mean age of 46.1 years. Antemortem diagnosis was not made in any of these patients. Eight patients each (35.6%) showed isolated left-sided and multichambered involvement, while the rest of the hearts (64.4%) had thrombi in the right-sided chamber(s). The recognizable risk factors were underlying cancers (24.4%), prolonged immobilization (20%), systemic lupus erythematosus (6.7%), pregnancy (4.4%), nephropathy (4.4%), primary antiphospholipid antibody syndrome (2.2%), and ulcerative colitis (2.2%). However, 16 patients (35.7%) had no obvious predisposing factor, although investigations for prothrombotic markers had not been done. Diabetes mellitus, chronic alcoholism, and deep vein thrombosis of the lower limbs had been clinically documented in some of them. The cause of death in most patients (73.3%) had been related to pulmonary and/or systemic thromboembolism. Conclusions This autopsy study emphasizes the great need for a higher index of suspicion of in situ thrombosis in the heart in hypercoagulable states so as to curtail the morbidity and mortality of the primary disease process.

Nosocomial cardiac infections are most often related to interventions performed within the preceding one to two months of hospital admission and usually affect the endocardium or prosthetic devices. These can be sometimes caused by fungi, especially the molds. This is a report of rare fungal pancarditis seen as hospital-acquired infection in two patients who were admitted in the intensive care unit for leptospirosis. The cardiac manifestation was part of systemic mycosis; mechanical ventilation, administration of steroids and hepatorenal failure were the risk factors. Incidentally, both the patients had underlying intrinsic cardiac disease.

Introduction Infective endocarditis (IE) of the pulmonary valve is uncommon and usually occurs in conjunction with tricuspid and/or left-sided valvular endocarditis. There have been only sporadic reports of isolated pulmonary valvular infective endocarditis (PVIE). This report documents the pathological features of nine such cases at autopsy. Methods Among 155 cases of IE encountered in a 14-year period, we selected nine cases that had isolated PVIE for analysis. The clinical records were reviewed for the patient demographics, presence or absence of underlying cardiac disease or other predisposing factors, and modes of presentation; these were correlated with the relevant investigations. A detailed study of the heart was done in all with special attention to the pulmonary valve morphology. Results The nine cases of isolated PVIE formed 5.8% of the IE cases, seen in six males and three females, largely adults. Seven patients (77.8%) had admissions for about 24 h. Hospital admission was sought for mainly progressive shortness of breath (66.7%) and fever (44.4%). Congenital heart disease was seen in seven (77.8%); two (an infant and an adult) had normal hearts. A single blood sample for blood culture in two patients was negative. Two-dimensional echocardiography, performed in eight, revealed vegetations on the pulmonary valve in four. The pulmonary valve was tricuspid in six cases, bicuspid in two, and unicuspid in one. The vegetations (active in three, active and healing in two, healed in four) were accompanied by concomitant thickening, shortening, perforations, or complete destruction of the cusps. Involvement of the right ventricular outflow tract or the main pulmonary artery was identified in five hearts. Five patients (55.6%) developed pulmonary complications, related to the endocarditis. Conclusions Detection of PVIE, especially the isolated type, may be underdiagnosed. This condition should be kept in mind during evaluation of patients especially with cardiac anomalies, who present with fever, prominent respiratory symptoms, and negative blood cultures.

Localization of hydatid cysts in the heart is a rare phenomenon, with an incidence of 0.5-2%. In almost half these cases, the heart is the sole organ to be involved. We report a case of massive pericardial hydatidosis in a female patient who presented with features of congestive cardiac failure. Cysts in the endocardium of right side of the heart resulted in fatal pulmonary embolism.

Summary Objectives Leptospiral involvement of the cardiovascular system often remains an under-estimated critical clinical factor. This report studied the cardiovascular changes in fatal cases of leptospirosis in Mumbai city, India in the year 2005. Methods This is a year's retrospective study of autopsied cases of leptospirosis, selected on the basis of clinical criteria. The demographic details, clinical presentation, and investigations were noted. Detailed gross examination of the cardiovascular system was carried out and multiple sections were taken. Results Forty-four cases of leptospirosis in the year 2005 formed 3.52% of the autopsies performed. The highest number of cases (25 patients) was seen in the month of August that corresponded to the deluge on the 26th of July. The majority (86%) were adults; all presented as acute febrile illness that terminated with severe respiratory insufficiency. Involvement of the cardiovascular system was found in 41 cases, an incidence of 93.2%. Clinical evidence of cardiac affection was not noted in most. Gross cardiac features noted were cardiomegaly and petechiae in one or more layers. The predominant feature on histopathological examination was the presence of interstitial myocarditis (100% of cases), with involvement of the epicardium/endocardium (39%), valves (36%), coronary arteries (51%) and aorta (56%). Conclusions Correlating the autopsy, leptospirosis can be visualized as an infective systemic vasculitis. The unusual manifestation of pulmonary hemorrhagic syndrome in these cases camouflaged the cardiovascular involvement.

Pericardial tumors are rare. A majority of the reported cases are metastatic in nature and indicate a poor prognosis. Primary tumors of the pericardium are extremely rare and occur in a broad age range. This review describes several of the more common lesions: germ cell tumors, solitary fibroma, pericardial mesothelioma, and metastatic disease.

Subvalvular left ventricular aneurysms can be subaortic or submitral with variable etiology. This is a retrospective study of 19 subvalvular aneurysms seen in 16 cases. There were 12 isolated subaortic aneurysms, 3 isolated submitral aneurysms, and in 1 case with multiple subaortic and submitral aneurysms. Subaortic aneurysms were associated with infective endocarditis, while there seems to be a strong association between submitral aneurysms and tuberculosis. Five cases of subvalvular aneurysm has associated aneurysm sinus of Valsalva-this association suggests a congenital weakness in the attachment of aortic and mitral annuli to the underlying myocardium. Cardio Pathol 2000;9:267-271

We evaluated the pathologic findings at autopsy in 337 patients who had undergone cardiac valve replacement over 10 years (1982 to 1991). Rheumatic heart disease was the most common indication for valve replacement (84% of cases). Among the 255 patients with short-term survival (

Atypical coarctation of the aorta refers to narrowing (discrete or diffuse) that involves the thoracic or abdominal segments. Such a phenomenon has never been reported in the inferior vena cava. This is a report of combined coarctation of the abdominal aorta and inferior caval vein in a still birth with sirenomelia, ambiguous genitalia, and other extracardiac anomalies. The maternal serum was positive for Toxoplasma and CMV. Evidence of phlebitis was present in the inferior caval vein.

Tuberculosis is rampant in a developing country thrombotic material. A longitudinal section through like ours. Despite this, the cardiovascular manithis area (Fig. 1) revealed adherence of thrombi to festation is largely restricted to chronic pericardial gray white opaque area in the septal myocardium. inflammation. Rarely clinical abnormalities are produced by myocardial tuberculosis. We report a clinically silent miliary myocardial tuberculosis, presenting as intestinal gangrene.

Tuberculosis is a leading cause of death among women in the reproductive period. Studies suggest that immunobiologic changes in pregnancy influence tuberculosis. However there is a dearth of data on pathomorphology of tuberculosis in pregnancy. Aim To characterize pathomorphologic patterns, co-existing lesions and obstetric complications in maternal deaths associated with tuberculosis. Methods We performed a two-year retrospective study of all autopsies of maternal mortality associated with tuberculosis. Results Among 151 autopsies of maternal deaths a current clinical history or autopsy evidence of tuberculosis was noted in 14 patients. Six among these had died post-partum and four following spontaneous abortions. Multi-organ tuberculosis and isolated pulmonary tuberculosis was observed in ten and three patients respectively. One patient with on-going anti-tuberculosis treatment had massive hepatic necrosis but no tuberculosis at autopsy. Six patients had a poorly reactive tuberculosis pattern. Diffuse alveolar damage was noted in three, two patients each had intracardiac mural thrombi and brain infarcts, one had perforative peritonitis while another revealed features suggestive of aortitis. Fetal outcome was poor with only two live births. Discussion The study suggests that maternal mortality associated with tuberculosis commonly has a florid multi-organ involvement, is often poorly reactive and has a poor fetal outcome.

A two month-old-male infant was admitted with Case 1 breathlessness, fever, cough and feeding difficulty. The infant (weight: 2.86 kg) had tachycardia, respiraA two and half month-old-female was admitted tory distress and peripheral cyanosis. Systemic exwith acute breathlessness. On examination, the child amination revealed a grade 3/6 pansystolic murmur (weight: 1.3 kg) had tachycardia, respiratory distress in the left parasternal area with tender hepatomegaly. and pallor. A grade 5/6 continuous murmur in the A colour doppler study revealed atrial situs solitus, infraclavicular area and bilateral crepitations were ventricular inversion and a large muscular ventricular heard on auscultation. Investigations revealed septal defect. Despite appropriate treatment, the anaemia, hypoglycaemia, bilateral consolidation and infant expired. At autopsy, there was ventricular patent ductus arteriosus. Despite appropriate treatinversion with ventriculo-arterial concordance. The ment, the infant expired. At autopsy, the heart, apart ventricular chambers communicated via a large from the patent ductus arteriosus, showed a small muscular ventricular septal defect. The posterior wall opening in the postero-septal region of the left of the inverted left ventricle showed 0.7 cm opening ventricle below the mitral valve. The opening com(Fig. 2) of a muscular diverticulum, well demonmunicated with an outpouching that extended into the strated by CT scan (Fig. 1). posterior wall as seen in the post-mortem computed Ventricular aneurysms and diverticula are outtomographic (CT) scan (Fig. 1). This diverticulum pouchings of the ventricles. The terms, ‘aneurysm’ and ‘diverticula’ have been used interchangeably, though they are different entities. Ventricular aneurysms arise following myocardial damage, communicate with the main ventricular chamber by a

Tuberculosis (TB), a multi-systemic disease with myriad presentations and variable manifestations, is endemic in almost every part of the world and continues to remain the most common cause of infectious diseaserelated mortality and morbidity. The infection occurs most often via the pulmonary route through aerosols, producing pulmonary and/or extra-pulmonary disease. A remarkable feature of the organism M. tuberculosis is its ability to lie dormant within alveolar macrophages/granulomas that leads to active disease in 5–10% of immune-competent individuals; the endogenous reactivation usually causes abnormalities in the upper lobes of one or both lungs. Now, there has been a rise of progressive disease due to overt immune-suppression and emergence of drug-resistant strains. In the recent years, at autopsy, we have noted a definite affinity of the organisms for the intra-parenchymal bronchial tree with prominent or sole broncho-centric inflammation. The bronchial spread is often associated with consolidations (often in the lower lobes) and vasculitis. Many of the cases of miliary lesions are associated with diffuse alveolar damage and organizing pneumonia.

Myxomas are the most common clinically detected primary cardiac tumours, located predominantly in the left atrium. They occur sporadically in 90% of cases, especially women with mean age of 50 years. About 7% of cardiac myxomas occur in a setting wherein these tumors occur at atypical or multiple sites in young patients with extra-cardiac manifestations as well. This is designated as Carney’s complex, which may be familial or sporadic. Genetic studies have confirmed that these multi-systemic manifestations are a result of mutations in the gene located at 17q22-24 coding protein kinase A, regulatory subunit 1-α (PRKAR-1-α). We report a case of recurrent (tumours detected at the ages of 12 and 20 years), multifocal myxomas with associated facial pigmentations and mucocutaneous angiomyxomas in a 20-year-old male. Screening for mutations in our patient by Sanger sequencing on whole genome amplified DNA revealed a heterozygous deletion at c.353_356delTACC as confirmed using forward and reverse primers. This has not been reported in PRKAR-1-α mutation database. Such a mutation was not seen in the immediate family members, indicating the sporadic nature of occurrence.

Background Infective endocarditis (IE) is increasingly perceived as a byproduct of aggressive medications and/or invasive medical procedures. In this situation, Candida species account for nearly half of all fungal IE. We report a single institute pathological experience of Candidal endocarditis (CE) among surgically excised cardiac tissues and autopsied cases. Methods This was a retrospective study of CE encountered at autopsy or as surgically excised specimens in a 14-year period (1999-2012). Each case was analysed with reference demographics, clinical presentation, underlying medical conditions, investigations, pathological findings and outcomes. Results CE was identified in 14 patients (7 males and females) with a mean age of 23.1 years, among the IE cases in surgically excised valves (4 of 38) and at autopsy (10 of 100). Twelve of the 14 cases were seen as health-care associated invasive infections, and only five had been diagnosed ante-mortem. CE was predominantly right-sided and valvular. The risk factors included underlying heart diseases, central venous catheterization and prolonged antibiotic therapy. Mortality among the autopsied patients was related to septicemia and/or embolic complications. Conclusions CE is emerging as an important hospital-acquired infection that requires rapid and sensitive techniques for identification and prompt medical and/or surgical therapy.

Background Today about 90% of children born with congenital heart disease (CHD) survive to adulthood, following improvements in diagnostic, interventional and critical care skills. The same scenario does not often exist in developing countries. Some of these anomalies (both simple and complex) may be detected in adults at autopsy, which is the theme of this study. Methods This is a retrospective analysis of adult CHD among autopsied patients 2007 to 2013.We categorized cases into diagnosed, undiagnosed and misdiagnosed CHDs, which were further classified depending on their complexity (low, moderate and severe) and this was correlated with clinical presentation. Results Among 59 adults with CHD, majority were males with an age range of 20 to 70 years. Of these, 28 defects were undiagnosed, 21 previously diagnosed, while 10 were misdiagnosed. In all categories the commonest presenting symptom was dyspnoea on exertion (32 patients), attributed to cardiac disease in 26 patients. Congenital aortic valvular malformations (low complexity) were the most common lesions in all categories, but 12 patients had lesions of moderate or severe complexity. Conclusions Every adult patient presenting with cardiac or respiratory symptoms should be thoroughly investigated not only for acquired causes but also for certain congenital heart diseases.

Non-trophoblastic cancers complicating pregnancy are rare with an incidence of approximately 1 in 1000 pregnancies, common sites being female genital tract and breast. We report a series of seven pregnancy associated cancers in a six year period (2009-2014). The patients ranged in age from 22-38 years (mean age 27.7 years). An antemortem diagnosis was made in four patients, the gestational age ranging from 12 weeks to 28 weeks. They presented with mass lesions and site associated symptoms. These included dys-germinoma of the left ovary, serous papillary tumour of borderline malignancy involving the right ovary, angiosarcoma of the left breast and left frontal anaplastic oligodendroglioma. Surgical excision was performed in all four cases with two postoperative deaths. The remaining three cancers were encountered at autopsy, the gestational age ranging from 31-37 weeks. These patients presented with acute febrile illness, dysphagia with multiple subcutaneous nodules and generalized weakness which were due to pulmonary giant cell carcinoma, esophageal adeno-squamous carcinoma and hematologic malignancy, respectively. Cancers associated with pregnancy tend to have aggressive course with poor prognosis.

Background Intestinal gangrene usually results from occlusion of the mesenteric vasculature, both arterial and venous, which may be luminal, mural or extramural. Sometimes the sources of luminal occlusion are thrombi originating in the heart or aorta. Our aim was to study intestinal gangrene caused by cardio-aortic disease. Methods In a retrospective analysis of 940 autopsies performed in a two year period, patients presenting as acute abdomen were reviewed. Among these, cases with intestinal gangrene caused by a cardio-aortic pathology were analysed with reference to the demographics, clinical symptomatology and investigations. Results Among 32 cases with intestinal gangrene, 14 patients had a cardio-aortic pathology. There were nine were females and five males (ratio of 1.8:1). The age range was from 21 to 70 years with a mean age of 48.42 years. Seven had mural thrombi in the left ventricle or atria related to ischemic or valvular heart diseases. The other seven had aortic disease (atherosclerosis or aortitis) with superimposed thrombi. Conclusions In cases of acute abdomen due to intestinal gangrene, it is important to examine the heart and aorta for the source of thrombo-emboli.

We report a paradoxical occurrence of left ventricular thrombus due to endomyocardial fibrosis in a six years male child diagnosed as Glanzmann thrombasthenia. Such an association has not been reported in literature.

In the natural history of all aneurysms in general thickening of the wall. The intima showed small, and aortic aneurysms in particular, rupture is the most gelatinous, translucent grey-white plaques separated common and dreaded complication. Aneurysms of by vertical scars. Such changes, ‘tree-bark’ appearthe thoracic portions of the aorta can rupture into the ance, were also seen in the arch and proximal 1.5 cm pericardial cavity, mediastinum or lungs. Rupture into of the thoracic aorta. The gross impression of the pulmonary trunk is an unusual and rare complicasyphilitic aortitis was confirmed on histology. VDRL tion. One such case in a 40-year-old male with was also positive in the post-mortem serum sample. syphilitic ascending aortic aneurysm is reported. Besides aortic regurgitation, the added complication was a large saccular aneurysm (5 cm diameter) which arose 2.5 cm above the sino-tubular junction. 1. Case report The lumen contained laminated thrombi and the wall was irregularly thinned out. Interestingly, the A 40-year-old man was hospitalised for progresaneurysm communicated with the right pulmonary sive dyspnoea, oedema feet and palpitations for past artery through a small, 0.5 cm opening (Fig. 1). ten days. On examination, the pulse was 82 per There was multiple large foci of haemorrhage in the minute and regular. The blood pressure was 140/60 right lung. mmHg. There was ventricular heave and thrill in the left second intercostal space in the mid-clavicular line with a pansystolic murmur on auscultation. A clinical 2. Discussion diagnosis of a subpulmonic ventricular septal defect or patent ductus arteriosus was entertained. The Rupture of an aortic aneurysm into the pulmonary patient had a fall in the bathroom and was found to artery with a fistulous communication is a rare event be acutely breathless and cyanosed. Efforts at resusciwith an incidence around 3% [1]. It occurs secondary tation failed. to trauma [2], aortic dissection [3] and syphilitic A complete autopsy was performed. The heart aortitis [4,5]. The reported case was a 40-year-old weighed 690 g and had moderate concentric left man with syphilitic aortitis and a large saccular ventricular hypertrophy. The aortic annulus was aneurysm of the ascending aorta. The rarity of dilated with separation of commissures and rounding cardiovascular syphilitis has been frequently stressed of the cuspal free margins, indicative of aortic in Western literature; however in India, it continues to regurgitation. The ascending aorta was dilated with remain one of the commonest causes of aortic

A left-sided fungal (Candidial) intracardiac mass was found at autopsy in a 38-day premature infant with hydrops foetalis. Such a manifestation of systemic candidiasis has not been reported previously.