[318] A Silent Cause of Sudden Cardiac Death: Anomalous Coronary Arteries

Sharleen F Hill, Mary N Sheppard. Imperial College London, London, United Kingdom; Royal Brompton and Harefield NHS Trust Hospital, London, United Kingdom

Background: Pathologists performing examinations on hearts of sudden cardiac death (SCD) victims are not actively excluding anomalous coronary arteries (ACA) as a cause of death. Our aim is to increase awareness of this cardiac anomaly, determine the incidence and educate the pathologist on a systematic approach to examining the coronary arteries.
Design: Retrospective non-case controlled analysis.
Setting: Cardiac pathology centre at the National Heart and Lung Institute and Royal Brompton Hospital.
Subjects: Between 1994 and 2011, the hearts of 2030 SCD victims were referred for pathological assessment to ascertain the precise aetiology of SCD.
Results: Twenty-nine (1.4%) of the 2030 cases of SCD have been associated with ACA (22 men (76%) and 7 women (24% age range [16 months-63 years]). The specific anomalies identified were 10 cases of anomalous right coronary artery arising from the left aortic sinus; 6 cases of anomalous left coronary artery (LCA) arising from the right coronary sinus; 7 cases of myocardial bridging; 3 cases of coronary artery ostial stenosis/atresia 2 cases of anomalous origin of the LCA from the pulmonary artery; and 1 case of high take off. The anomalous coronary artery had been identified by the referring pathologist in only 11 of the 29 cases (38%). Histological evidence of acute/chronic ischaemia in the regional myocardium supplied by the ACA was evident in 23 of the 29 cases (79%). In 15 cases (52%) SCD occurred during or immediately after physical exertion. Cardiac symptoms were documented to have occurred in only 7 patients (24%) prior to SCD.
Conclusions: Anomalous coronary arteries are an under-recognised cause of sudden cardiac death. Detailed examination of the coronary artery system identifying both coronary artery ostia and their course should be routinely performed on SCD victims.
Category: Cardiovascular

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 40, Wednesday Afternoon


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