Vesterby A
Acta Pathol Microbiol Scand A. 1981 Mar;89(2):157-63. doi: 10.1111/j.1699-0463.1981.tb00202.x.
This study has been performed applying postmortem coronary angiography and histological investigation of the conduction system of the heart in 21 persons who died suddenly and unexpectedly because of coronary sclerosis. This "coronary group" is compared with a sex and age matched control group of 24 persons. Acute vascular lesions were found in 20 persons (95.2%), fresh infarctions in 10 (45%), heart rupture in 2 (9.5%) and old infarctions (indicated by localized fibrosis) in 7 (33.3%). The coronary arteries were graded using WHO's recommendations from 1958. Arteriosclerosis of the major coronary arteries was significantly more extensive in the "coronary group". The origin and course of the arteries to the conduction system were located by postmortem coronary angiography. The right coronary artery supplied these arteries in the majority of cases (sinus node artery 77%, a.-v. node artery 85%). A significantly greater degree of arteriosclerosis could be demonstrated histologically in the sinus node artery in the "coronary group". In both groups the degree of arteriosclerosis was greater in the a.-v. node artery than in the sinus node artery. The conduction system was investigated using Hudson's method. There were only 3 cases of infarction in the conduction system, possibly due to its greater resistance to damage from anoxia. In all patients "non-specific changes" (hemorrhage, small cellular infiltrations and/or degeneration) were found and these changes can, therefore, be of no pathophysiological importance in this group of patients. The degree of fibrosis and the amount of fat was semiquantified. Six patients in the "coronary group" had moderate fibrosis around the left sided fibres of the bundle of His. This leads to the conclusion that these changes might play a role in the fatal course, and that some cases of sudden, unexpected cardiac death can be explained by pre-existing fibrosis in the conduction system.
本研究对21例因冠状动脉硬化突然意外死亡者进行了死后冠状动脉造影及心脏传导系统组织学研究。将该“冠心病组”与24例性别和年龄匹配的对照组进行比较。发现20例（95.2%）有急性血管病变，10例（45%）有新鲜梗死，2例（9.5%）有心脏破裂，7例（33.3%）有陈旧性梗死（以局部纤维化为指标）。冠状动脉按照世界卫生组织1958年的建议分级。“冠心病组”主要冠状动脉的动脉硬化明显更广泛。通过死后冠状动脉造影确定了供应传导系统的动脉的起源和走行。大多数情况下，右冠状动脉供应这些动脉（窦房结动脉占77%，房室结动脉占85%）。“冠心病组”窦房结动脉在组织学上显示出明显更严重的动脉硬化程度。两组中，房室结动脉的动脉硬化程度均高于窦房结动脉。采用哈德森方法对传导系统进行研究。传导系统仅有3例梗死，可能是由于其对缺氧损伤的抵抗力更强。在所有患者中均发现了“非特异性改变”（出血、小细胞浸润和/或变性），因此，这些改变在该组患者中可能无病理生理意义。对纤维化程度和脂肪量进行了半定量。“冠心病组”中有6例在希氏束左侧纤维周围有中度纤维化。由此得出结论，这些改变可能在致命病程中起作用，并且一些突然意外的心脏死亡病例可以用传导系统中预先存在的纤维化来解释。
