Paz Suárez-Mier M, Aguilera B
Institute of Toxicology, Histopathology Section, Madrid, Spain.
Forensic Sci Int. 1998 May 11;93(2-3):143-54. doi: 10.1016/s0379-0738(98)00046-2.
Because ventricular fibrillation or other arrhythmia have been suggested as a cause of unexplained sudden infant death, many authors focused their studies on the conduction system especially in the 1970s. These studies were not conclusive and many pathologists have abandoned the study of the conduction system. We have reviewed the conduction system of 87 sudden infant death cases between 15 days and 1 year old: 55 were SIDS cases; 17 had mild lesions insufficient to explain death and 15 cases were sudden explained deaths considered as controls. Fetal dispersion of the AV node and/or His bundle and left-sided His bundle, the most frequent findings in the three groups, can be considered normal variations. Nodoventricular tracts were observed in five cases from the three groups whereas fasciculoventricular tracts were present in seven cases of the SIDS group, one case of the second group and in no controls. We consider the possible pathologic significance of this accessory pathway in some SIDS cases. Other infrequent lesions were fibromuscular hyperplasia of AV node artery and His bundle hemorrhage in one SIDS case each; lymphocytic infiltration of the conduction system in one SIDS case and one case with myocarditis and left bundle branch fibrosis in a female infant with endocardial fibroelastosis.
由于室颤或其他心律失常被认为是不明原因婴儿猝死的一个原因，许多作者尤其在20世纪70年代将他们的研究集中在传导系统上。这些研究没有定论，许多病理学家已经放弃了对传导系统的研究。我们回顾了87例15天至1岁婴儿猝死病例的传导系统：55例为婴儿猝死综合征（SIDS）病例；17例有轻度病变不足以解释死亡原因，15例为有明确死因的猝死病例作为对照。房室结和/或希氏束以及左侧希氏束的胎儿期离散，这在三组中最常见的发现，可以被认为是正常变异。在三组中的5例中观察到结室束，而在SIDS组的7例、第二组的1例中存在分支室束，对照组中未发现。我们考虑了这种附加通路在一些SIDS病例中的可能病理意义。其他罕见病变包括1例SIDS病例中房室结动脉的纤维肌性增生和1例SIDS病例中希氏束出血；1例SIDS病例中传导系统的淋巴细胞浸润，以及1例患有心内膜弹力纤维增生症的女婴中合并心肌炎和左束支纤维化。
