Abstract
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.
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References
Lev M, Bharati S (1974) Lesions of the conduction system and their functional significance. Pathol Annu 9:157–207
Bharati S, Bauernfeind R, Miller LB, Strasberg B, Lev M (1983) Sudden death in three teenagers: conduction system studies. J Am Coll Cardiol 1:879–886
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 134:282–291
James TN, Froggatt P, Marshall TK (1967) Sudden death in young athletes. Ann Intern Med 67:1013–1021
Anderson KR, Bowie J, Dempster AG, Gwynne JF (1981) Sudden death from occlusive disease of the atrioventricular node artery. Pathology 13:417–421
Anderson KR, Hill RW (1982) Occlusive lesions of cardiac conducting tissue arteries in sudden infant death syndrome. Pediatrics 69:50–52
Nichols GR, Davis GJ, Lefkowitz JB (1989) Sudden death due to fibromuscular dysplasia of the sinoatrial nodal artery. J Ky Med Assoc 87:504–505
Zack F, Terpe H, Hammer U, Wegener R (1996) Fibromuscular dysplasia of coronary arteries as a rare cause of death. Int J Legal Med 108:215–218
Jing HL, Hu BJ (1997) Sudden death caused by stricture of the sinus node artery. Am J Forensic Med Pathol 18:360–362
Lee AHS, Gray PB, Gallagher PJ (2000) Sudden death and regional left ventricular fibrosis with fibromuscular dysplasia of small intramyocardial coronary arteries. Heart 83:101–102
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
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 116:344–349
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
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 111:884–892
Hudson REB (1963) The human conducting-system and its examination. J Clin Pathol 16:492–498
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 3:53–76
Burke AP, Subramanian R, Smialek J, Virmani R (1993) Nonatherosclerotic narrowing of the atrioventricular node artery and sudden death. J Am Coll Cardiol 21:117–122
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 23:12–16
James TN, Marshall TK (1976) XVIII. Persistent fetal dispersion of the atrioventricular node and His bundle within the central fibrous body. Circulation 53:1026–1034
Anderson RH, Becker AE (1980) Cardiac anatomy. Gower Medical Publishing, London
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
Davies MJ, Anderson RH, Becker AE (1983) The conduction system of the heart. Butterworth, London
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 32:1885–1890
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 117:193–203
Hecht FM (1980) Studie über quantitative Altersveränderungen am Hisschen Bündel des Menschen. Virchows Arch A Pathol Anat Histol 386:343–356
Schneider J (1981) Der plötzliche Herztod als Folge einer Reizleitungsstörung. I. Teil. Quantitative Pathologie der Reizbildungs- und Reizleitungsstörungen. Schweiz Med Wochenschr 111:366–374
Patel J, Sheppard MN (2011) Cystic tumour of the atrioventricular node: three cases of sudden death. Int J Legal Med 125:139–142
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 452:11–18
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Zack, F., Rodewald, AK., Blaas, V. et al. 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. Int J Legal Med 130, 173–178 (2016). https://doi.org/10.1007/s00414-015-1287-y
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DOI: https://doi.org/10.1007/s00414-015-1287-y