Sacrifical heart not dropping after entering Cruel

Despite returning to Aggorat and fully clearing the area four times, I have been unable to find the Sacrificial Heart, so I've effectively lost two skill points. I did not find the heart in my first playthrough, never knew of its existence, and kept advancing.

Hi , so i figured out that even if you dont have a sacrificial heart in your inventory you can still go to aggorat and use dagger to stab the heart , it should work and give you 2 passive skill points , cheers !