Histologic spectrum of the cardiac conducting tissue in non-natural deaths under 30 years of age: an analysis of 43 cases with special implications for sudden cardiac death

详细信息    查看全文

• 作者：Fred Zack ; Ann-Katrin Rodewald ; Verena Blaas…
• 关键词：Cardiac conduction system ; Histological findings ; Anatomical variations ; Diagnostic error ; Cause of death
• 刊名：International Journal of Legal Medicine
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：130
• 期：1
• 页码：173-178
• 全文大小：2,257 KB
• 参考文献：1.Lev M, Bharati S (1974) Lesions of the conduction system and their functional significance. Pathol Annu 9:157–207PubMed
  2.Bharati S, Bauernfeind R, Miller LB, Strasberg B, Lev M (1983) Sudden death in three teenagers: conduction system studies. J Am Coll Cardiol 1:879–886PubMed CrossRef
  3.Burke AP, Farb A, Tang A, Smialek J, Virmani R (1991) Fibromuscular dysplasia of small coronary arteries and fibrosis in the basilar ventricular septum in mitral valve prolapse. Am Heart J 134:282–291CrossRef
  4.James TN, Froggatt P, Marshall TK (1967) Sudden death in young athletes. Ann Intern Med 67:1013–1021PubMed CrossRef
  5.Anderson KR, Bowie J, Dempster AG, Gwynne JF (1981) Sudden death from occlusive disease of the atrioventricular node artery. Pathology 13:417–421PubMed CrossRef
  6.Anderson KR, Hill RW (1982) Occlusive lesions of cardiac conducting tissue arteries in sudden infant death syndrome. Pediatrics 69:50–52PubMed
  7.Nichols GR, Davis GJ, Lefkowitz JB (1989) Sudden death due to fibromuscular dysplasia of the sinoatrial nodal artery. J Ky Med Assoc 87:504–505PubMed
  8.Zack F, Terpe H, Hammer U, Wegener R (1996) Fibromuscular dysplasia of coronary arteries as a rare cause of death. Int J Legal Med 108:215–218PubMed CrossRef
  9.Jing HL, Hu BJ (1997) Sudden death caused by stricture of the sinus node artery. Am J Forensic Med Pathol 18:360–362PubMed CrossRef
  10.Lee AHS, Gray PB, Gallagher PJ (2000) Sudden death and regional left ventricular fibrosis with fibromuscular dysplasia of small intramyocardial coronary arteries. Heart 83:101–102PubMed PubMedCentral CrossRef
  11.Cohle SD, Suarez-Mier MP, Aguilera B (2002) Sudden death from lesions of the cardiac conduction system. Am J Forensic Med Pathol 23:83–89
  12.Nishida N, Ikeda N, Kudo K, Tsuji A, Kiyoshima A (2002) Forensic significance of conduction system abnormalities as a precise cause of accidental death. Int J Legal Med 116:344–349PubMed
  13.Curca GC, Sarbu N, Dermengiu D, Dermengiu S, Martius E, Rusu M, Hostiuc S (2009) Coronary fibromuscular dysplasia and sudden death—case report and literature review. Rom J Leg Med 3:165–172
  14.Schneider J (1981) Der plötzliche Herztod als Folge einer Reizleitungsstörung. III. Teil. Ist der sogenannte idiopathische AV-Block Folge einer kongenitalen Entwicklungsstörung? Schweiz Med Wochenschr 111:884–892PubMed
  15.Hudson REB (1963) The human conducting-system and its examination. J Clin Pathol 16:492–498PubMed PubMedCentral CrossRef
  16.Cohle SD, Lie JT (1998) Histopathologic spectrum of the cardiac conducting tissue in traumatic and noncardiac sudden death patients under 30 years of age: an analysis of 100 cases. Anat Pathol 3:53–76PubMed
  17.Burke AP, Subramanian R, Smialek J, Virmani R (1993) Nonatherosclerotic narrowing of the atrioventricular node artery and sudden death. J Am Coll Cardiol 21:117–122PubMed CrossRef
  18.Zack F, Kutter G, Blaas V, Rodewald AK, Büttner A (2014) Fibromuscular dysplasia of cardiac conduction system arteries in traumatic and nonnatural sudden death victims aged 0 to 40 years: a histological analysis of 100 cases. Cardiovasc Pathol 23:12–16PubMed CrossRef
  19.James TN, Marshall TK (1976) XVIII. Persistent fetal dispersion of the atrioventricular node and His bundle within the central fibrous body. Circulation 53:1026–1034PubMed CrossRef
  20.Anderson RH, Becker AE (1980) Cardiac anatomy. Gower Medical Publishing, London
  21.Suarez-Mier MP, Fernández-Lozano I (2015) Pathology of the cardiac conduction system. In: Lucena JS, Garcia-Pavia P, Suarez-Mier MP, Alonso-Pulpon LA (eds) Clinico-pathological atlas of cardiovascular diseases. Springer International Publishing, Switzerland, pp 265–297
  22.Davies MJ, Anderson RH, Becker AE (1983) The conduction system of the heart. Butterworth, London
  23.Suarez-Mier MP, Gamallo C (1998) Atrioventricular node fetal dispersion and His bundle fragmentation of the cardiac conduction system in sudden cardiac death. J Am Coll Cardiol 32:1885–1890PubMed CrossRef
  24.Bajanowski T, Ortmann C, Teige K, Wedekind H, Zack F, Röse I, Brinkmann B (2003) Pathological changes of the heart in sudden infant death. Int J Legal Med 117:193–203PubMed CrossRef
  25.Hecht FM (1980) Studie über quantitative Altersveränderungen am Hisschen Bündel des Menschen. Virchows Arch A Pathol Anat Histol 386:343–356PubMed CrossRef
  26.Schneider J (1981) Der plötzliche Herztod als Folge einer Reizleitungsstörung. I. Teil. Quantitative Pathologie der Reizbildungs- und Reizleitungsstörungen. Schweiz Med Wochenschr 111:366–374PubMed
  27.Patel J, Sheppard MN (2011) Cystic tumour of the atrioventricular node: three cases of sudden death. Int J Legal Med 125:139–142PubMed CrossRef
  28.Basso C, Burke M, Fornes P, Gallagher PJ, de Gouveia RH, Sheppard M, Thiene G, van der Wal A (2008) Guidelines for autopsy investigation of sudden cardiac death. Virchows Arch 452:11–18PubMed CrossRef
  
• 作者单位：Fred Zack (1)
  Ann-Katrin Rodewald (1)
  Verena Blaas (1)
  Andreas Büttner (1)
  
  1. Rostock University Medical Center, Rostock, Germany
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Forensic Medicine
  Medical Law
  Medicine/Public Health, general
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1437-1596

文摘

In the past, histological findings of the cardiac conduction system or its adjacent structures, such as filiform fibers at the transition from bundle of His to bundle branches, connective tissue at the apex of the ventricular septum, or fibromuscular alterations of the arteries has been considered as a cause of death. However, the prevalence of such findings in a healthy population has been rarely analyzed systematically. In the present study, the morphology of the cardiac conduction system of 43 heart-healthy individuals who died of non-natural causes (ages 0 to 30 years) was investigated. In a high percentage of cases, connective tissue at the apex of the ventricular septum (97.7 %), filiform fibers at the transition from bundle of His to the bundle branches (27.9 %), and fibromuscular proliferations of the sinoatrial node artery (41.9 %), and the AV-node artery (39.5 %) could be detected. Based on our observations, these alterations should not be considered as a pathologic entity or as a cause of death. Keywords Cardiac conduction system Histological findings Anatomical variations Diagnostic error Cause of death