Bharati S, Bauernfeind R, Miller L B, Strasberg B, Lev M
J Am Coll Cardiol. 1983 Mar;1(3):879-86. doi: 10.1016/s0735-1097(83)80203-4.
The pathologic substrate for sudden death in the middle-aged or elderly adult is usually ischemic heart disease. In contrast, few data are available regarding the pathology of sudden death in teenagers. This report describes three teenagers without clinically suspected heart disease dying suddenly. Patient 1 (age 15, male) was known to have right ventricular premature ventricular beats. Postmortem examination revealed marked premature aging, sclerosis of the cardiac skeleton extending to the right side of the summit with fibrosis of the left and right bundle branches. Patient 2 (age 17, male) was a trained athlete who died during football scrimmage. Autopsy revealed moderate mitral valve prolapse and marked premature aging, sclerosis of the left side of the cardiac skeleton, which extended to the right ventricular side, and secondary involvement of the trifascicular conduction system with mononuclear cell infiltration. Patient 3 (age 19, female) died suddenly at home. Autopsy revealed mitral valve prolapse, thrombosis of the sinoatrial (SA) node artery, and premature aging, sclerosis of the left side of the cardiac skeleton, with involvement of the ventricular septum more on the right ventricular side and involvement of the atrioventricular bundle and trifascicular conduction system. In conclusion, unexpected deaths in three teenagers occurred with demonstrable pathologic findings in the heart. Two of the three patients had mitral valve prolapse, one of whom also had thrombosis or embolism of the sinoatrial node artery. All three had sclerosis of not only the left side but also the right side of the ventricular septum with involvement of the conduction system. The anatomic substrate demonstrated in these three patients could relate to lethal bradyarrhythmia or tachyarrhythmia, or both.
中年或老年成人猝死的病理基础通常是缺血性心脏病。相比之下，关于青少年猝死的病理学资料很少。本报告描述了3名无临床疑似心脏病的青少年突然死亡的情况。患者1（15岁，男性）已知有右室室性早搏。尸检显示明显的过早衰老，心脏骨骼硬化延伸至心尖右侧，左右束支纤维化。患者2（17岁，男性）是一名受过训练的运动员，在足球对抗赛中死亡。尸检显示中度二尖瓣脱垂，心脏骨骼左侧明显过早衰老、硬化，延伸至右室侧，三分支传导系统继发单核细胞浸润。患者3（19岁，女性）在家中突然死亡。尸检显示二尖瓣脱垂，窦房结动脉血栓形成，心脏骨骼左侧过早衰老、硬化，右室侧室间隔受累更明显，房室束和三分支传导系统也受累。总之，3名青少年意外死亡，心脏有明显的病理发现。3名患者中有2名有二尖瓣脱垂，其中1名还有窦房结动脉血栓形成或栓塞。3人都有室间隔左右两侧的硬化并累及传导系统。这3名患者中显示的解剖学基础可能与致命性缓慢性心律失常或快速性心律失常，或两者都有关。
