Desai Saral, Sheppard Mary N
Department of Histopathology, Royal Brompton Hospital, Sydney Street, London, UK.
Am J Forensic Med Pathol. 2012 Mar;33(1):26-9. doi: 10.1097/paf.0b013e3181e29598.
Spontaneous coronary artery dissection is a rare cause of death seen largely in young women, with many cases occurring in the early postpartum period. Nine cases with this condition were examined from our histopathology records comprising 6 women and 3 men with an age range of 26 to 47 years. All deaths were sudden, and only one patient complained of chest pain and she was 8 weeks postpartum. All cases showed dissection macroscopically, though 4 of the 6 cases, which were sent for a second opinion, were described as having normal coronaries by the referring pathologists. One heart seemed to have postmortem coronary artery thrombus and dissection was difficult to discern on gross examination. All cases were examined histologically and confirmed acute dissection of the coronary arteries, with more than 2 arteries affected in 2 cases. Histologic features of myocardial ischemia/infarction were noted in 4 cases so the explanation for the sudden death in the other 4 cases remains a possible fatal arrhythmia. The macroscopic changes in the heart of acute coronary artery dissection can be difficult to detect and can be easily mistaken for postmortem clot or a thrombus overlying an atheromatous plaque. All such cases with thrombus in the arteries, even the normal-looking coronary arteries, in young adults should be examined microscopically for dissection
自发性冠状动脉夹层是一种罕见的死亡原因，主要见于年轻女性，许多病例发生在产后早期。我们从组织病理学记录中检查了9例这种情况的病例，包括6名女性和3名男性，年龄在26至47岁之间。所有死亡均为突然发生，只有一名患者诉说胸痛，她处于产后8周。所有病例在宏观上均显示有夹层，尽管送去二次会诊的6例病例中有4例，转诊病理学家描述其冠状动脉正常。一颗心脏似乎有死后冠状动脉血栓形成，大体检查时夹层难以辨别。所有病例均进行了组织学检查，证实为冠状动脉急性夹层，2例中有2条以上动脉受累。4例中观察到心肌缺血/梗死的组织学特征，因此另外4例猝死的原因可能是致命性心律失常。急性冠状动脉夹层心脏的宏观变化可能难以检测，并且很容易被误认为是死后血栓或覆盖在动脉粥样硬化斑块上的血栓。所有这类动脉中有血栓的病例，即使冠状动脉外观正常，在年轻人中也应进行显微镜检查以确定是否存在夹层。
