Bifid cardiac apex as an incidental autopsy finding: differentiation from apical notch. Report of two forensic cases and a literature review.

A bifid cardiac apex is a rare congenital anomaly resulting from the nonunion of the right and left ventricles at the cardiac apex, producing two distinct apical projections with a cleft between them. This article illustrates two cases with a bifid apex: the first with a deep cleft and the other with an apparently superficial indentation. Dissection of the heart confirmed separation of the myocardium of both ventricles at the apex. Both cases were free of other congenital anomalies, and the cause of death was unrelated to the bifid apex. We also present a case of a prominent apical notch that might simulate a bifid apex; however, dissection demonstrated myocardial continuity. In addition, we summarized ten autopsy cases of bifid apices reported in the literature. Five cases had other concomitant fatal congenital cardiac anomalies. In four cases, a bifid apex was the sole congenital anomaly, and the patients died from poisoning, sickle cell disease, road traffic accidents, and drowning. In one case, the death was attributed to myocarditis, which was also unrelated to the bifid apex. The incidental discovery of a bifid apex at autopsy indicates its benign nature. Therefore, forensic medicine professionals must not attribute death to a bifid apex and must determine the actual cause of death. Most importantly, the presence of a bifid apex mandates a search for potential associated congenital anomalies through comprehensive cardiac dissection.