Author + information
- Received September 13, 1982
- Revision received October 26, 1982
- Accepted October 29, 1982
- Published online March 1, 1983.
- Saroja Bharati, MD, FACC*,a,
- Robert Bauernfeind, MD, FACC,
- Lynn B. Miller, MD, FACC,
- Boris Strasberg, MD, FACC and
- Maurice Lev, MD, FACCa
- ↵*Address for reprints: Saroja Bharati, MD, Department of Pathology, Deborah Heart and Lung Center, Browns Mills, New Jersey 08015.
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 septumwith involvement of the conduction system. The anatomic substrate demonstrated in these three patients could relate to lethal bradyarrhythmia or tachyarrhythmia, or both.
↵a Present address for Drs. Bharati and Lev: Department of Pathology, Deborah Heart and Lung Center, Browns Mills, New Jersey
This study was aided by Grant HL 07605 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and the National Institutes of Health, Bethesda, Maryland
- Received September 13, 1982.
- Revision received October 26, 1982.
- Accepted October 29, 1982.
- American College of Cardiology Foundation