Cocco P, Thiene G, Corrado D, Lodovichetti G, Pennelli N
Istituto di Anatomia Patologica, Università degli Studi, Padova.
G Ital Cardiol. 1990 Sep;20(9):795-800.
Two women, 34 and 54 years old, died suddenly from acute coronary occlusion due to spontaneous dissecting haematoma (aneurysm) involving the entire left coronary artery and the right coronary artery, respectively. In the older woman, cystic medial necrosis of the coronary tunica media was observed. The younger case was the only sudden death due to dissecting hematoma among 120 cases in the Registry of "juvenile sudden death" in the Veneto Region, Italy. From a review of the literature, following the first description in 1931, we collected 97 cases with the following characteristics: mean age in women, 39 years, in men, 48 years; only significant risk factor: peripartum (34% of women); coronary arteries involved: isolated left anterior descending (52.5%, equally distributed among women and men), right (24%, mainly men), left (13.5%, only women), multiple vessels (8%), left circumflex artery (2%). The clinical presentation was cardiac arrest with sudden death in 49.5%, acute, non-fatal myocardial infarct in 33%, and acute fatal myocardial infarct in 17.5% of the cases. The prognosis is very poor, and emergency medical or surgical myocardial revascularization is rarely feasible.
两名女性，分别为34岁和54岁，因自发性夹层血肿（动脉瘤）分别累及整个左冠状动脉和右冠状动脉导致急性冠状动脉闭塞而突然死亡。在年长女性中，观察到冠状动脉中膜的囊性坏死。年轻病例是意大利威尼托地区“青少年猝死”登记处120例病例中唯一因夹层血肿导致的猝死。通过对文献的回顾，自1931年首次描述以来，我们收集了97例具有以下特征的病例：女性平均年龄39岁，男性平均年龄48岁；唯一显著的危险因素：围产期（女性的34%）；累及的冠状动脉：孤立的左前降支（52.5%，男女分布均等）、右冠状动脉（24%，主要为男性）、左冠状动脉（13.5%，仅女性）、多支血管（8%）、左旋支动脉（2%）。临床表现为心脏骤停伴猝死的占49.5%，急性非致命性心肌梗死的占33%，急性致命性心肌梗死的占17.5%。预后非常差，紧急医疗或手术心肌血运重建很少可行。
