Significance of microcirculatory disturbance of basilar ventricular septum in cases of sudden cardiac death

1.作者对60例心源性猝死心脏进行了检查，并与20例正常心脏进行了比较。心源性猝死者基底部室间隔小动脉及内皮细胞数量减少。结果表明，基底部小动脉和毛细血管相对减少导致的室间隔局部缺血可能是心源性猝死的原因之一.本文对80例非外伤性心肺复苏（CPR）患者的心脏传导系统进行了检查。80例中，7例局部出血和损伤明显，无炎症反应。可以推测，在CPR过程中，传导系统的损伤确实发生在有限的区域。我们提出两个极为罕见的尸检病例与闭锁的左冠状动脉口。病例1为34岁男性，死于心源性猝死;病例2为82岁女性，死于非心源性死亡。在这两个病例中，发现了一条位于正常位置的小左主干，但左冠状动脉开口缺失。侧支动脉的口径和/或其他解剖特征可能决定左冠状动脉口闭锁患者的临床病程。我们报告一位17岁的男性学生，其临床背景及病理表现与雷氏症候群相似。他的心脏显示出一些心脏异常结果，没有显示出任何Reye综合征的结果。本案似乎表明，在猝死的情况下，应非常仔细地确定RS的尸检诊断，即使一般情况似乎与RS一致。

1. Author examined 60 heart of sudden cardiac death and compared with 20 normal hearts. Possible significant decreasing of small arteries and endothelial cells were found in basilar ventricular septum in some cases of sudden cardiac death. This results showed localized ischemia in basilar ventricular septum due to relative decreasing of small arteries and capillaries in basilar may be one of the causes of sudden cardiac death.2. The cardiac conduction system of 80 hearts without gross injury from patients who had received cardiopulmonary resuscitation (CPR) due to non-traumatic causes was examined. Of these 80 cases, localized hemorrhage and injury without inflammatory reaction was evident in 7 of these cases. It can be presumed that injuries to the conduction system do occur in limited regions during CPR.3. We present two extremely rare autopsy cases with atresia of the left coronary ostium. Case 1 was a 34-year-old man who died of sudden cardiac death and Case 2 was an 82-year-old woman who died from non-cardiac causes. In both cases, a string-like small left main trunk that was located in its normal position was found, however the orifice of the left coronary artery was absent. The caliber and/or other anatomical features of the Collateral artery may predominantly dictate the clinical course of patients with atresia of the left coronary ostium.4. We report a case of sudden unexpected death in a 17-year-old male student showing similar clinical background and pathological findings to Reye's syndrome. His heart showed some cardiac abnormal findings and did not showed any findings of Reye's syndrome. The present case would seem to suggest that a postmortem diagnosis of RS should be determined very carefully in cases of sudden death, even if the general circumstances would seem to be consistent with RS.