Ottaviani Giulia, Ramos Simone G
Lino Rossi Research Center, Anatomic Pathology, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy.
Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil.
Diagnostics (Basel). 2023 May 31;13(11):1919. doi: 10.3390/diagnostics13111919.
Sudden unexpected death (SUD) is a fatal event that occurs in an apparently healthy subject in a way that such an abrupt outcome could have not been predicted. SUD-including sudden intrauterine unexplained death (SIUD), sudden neonatal unexpected death (SNUD), sudden infant death syndrome (SIDS), sudden unexpected death of the young (SUDY), and sudden unexpected death in the adult (SUDA)-occurs as the first manifestation of an unknown underlying disease or within a few hours of the presentation of a disease. SUD is a major unsolved, shocking form of death that occurs frequently and can happen at any time without warning. For each case of SUD, a review of clinical history data and performance of a complete autopsy, particularly focused on the study of the cardiac conduction system, were carried out according to the necropsy protocol devised by the Lino Rossi Research Center, Università degli Studi di Milano, Italy. Research cases collected and selected for this study were represented by 75 SUD victims that were subdivided into 15 SIUD, 15 SNUD, 15 SUDY, and 15 SUDA victims. After a routine autopsy and clinical history analysis, death remained unexplained, and hence a diagnosis of SUD was assigned to 75 subjects, which included 45 females (60%) and 30 (40%) males ranging in age from 27 gestational weeks to 76 years. Serial sections of the cardiac conduction system disclosed frequent congenital alterations of the cardiac conduction system in fetuses and infants. An age-related significant difference in distribution among the five age-related groups was detected for the following anomalies of the conduction system: central fibrous body (CFB) islands of conduction tissue, fetal dispersion, resorptive degeneration, Mahaim fiber, CFB cartilaginous meta-hyperplasia, His bundle septation, sino-atrial node (SAN) artery fibromuscular thickening, atrio-ventricular junction hypoplasia, intramural right bundle branch, and SAN hypoplasia. The results are useful for understanding the cause of death for all SUD cases that were unexpected and would have otherwise remained unexplained, so as to motivate medical examiners and pathologists to perform more in-depth studies.
猝死（SUD）是指在表面健康的个体中发生的致命事件，其结局如此突然，以至于无法预测。猝死包括宫内不明原因猝死（SIUD）、新生儿意外猝死（SNUD）、婴儿猝死综合征（SIDS）、青年意外猝死（SUDY）和成人意外猝死（SUDA），它是未知潜在疾病的首发表现，或者在疾病出现后的几个小时内发生。猝死是一种主要的、尚未解决的、令人震惊的死亡形式，经常发生且可能毫无预警地在任何时候出现。对于每一例猝死病例，均按照意大利米兰大学利诺·罗西研究中心制定的尸检方案，对临床病史数据进行了回顾，并进行了完整的尸检，尤其着重于心脏传导系统的研究。本研究收集并选取的研究病例为75例猝死受害者，分为15例宫内不明原因猝死、15例新生儿意外猝死、15例青年意外猝死和15例成人意外猝死受害者。经过常规尸检和临床病史分析后，死亡原因仍无法解释，因此将75名受试者诊断为猝死，其中包括45名女性（60%）和30名男性（40%），年龄范围从妊娠27周至76岁。心脏传导系统的连续切片显示，胎儿和婴儿的心脏传导系统频繁出现先天性改变。在五个年龄相关组中，以下传导系统异常在分布上存在与年龄相关的显著差异：传导组织的中央纤维体（CFB）岛、胎儿期离散、吸收性退变、Mahaim纤维、CFB软骨化生增生、希氏束分隔、窦房结（SAN）动脉纤维肌性增厚、房室交界发育不全、壁内右束支以及窦房结发育不全。这些结果有助于理解所有意外发生且原本无法解释的猝死病例的死亡原因，从而促使法医和病理学家进行更深入的研究。
