Substrates for sudden cardiac death

Sudden death of a 12-year-old boy with severe myocardial fibrosis due to inapparent chronic myocarditis

Sudden death due to unknown cardiac disease in children is an unusual occurrence. An apparently healthy 12-year-old boy without any physical restrictions collapsed suddenly and died despite cardiopulmonary resuscitation. The main autopsy finding was extensive scarring of the myocardium, especially the interventricular septum. This extensive scarring was exceptional for the young age. Histologically, replacement-type fibrosis with patchy lymphomonocytic infiltrate and infiltration by macrophages were observed. The case was diagnosed as chronic myocarditis, which may have progressed to dilated cardiomyopathy with inflammation or inflammatory cardiomyopathy.

"Grown-up" congenital heart disease and sudden death in a medical examiner's population

Despite advances in the management of congenital heart disease (CHD), children with CHD who survive into adulthood are at increased risk of sudden death. Sudden death may also be the initial presentation of undiagnosed CHD in some adults. This retrospective descriptive study outlines the spectrum of CHD presenting as sudden death in adults in a medical examiner's population. Despite its rarity (0.2% of all cases investigated between 1991 and 2007), CHD remains an important cause of sudden cardiac death to be recognized at adult autopsy. Bicuspid aortic valve and anomalous coronary anomalies were the most common malformations, comprising 36.9% and 26.2% of cases, respectively. However, a wide spectrum of simple to complex malformations can be seen, with or without prior surgery, and over a wide age spectrum. Once solely a pediatric entity, CHD is now "grown-up" and will likely be diagnosed by forensic pathologists with increased frequency in the future.