[Morphologic features of sudden cardiac death in Yunnan province, with emphasis on myocarditis].
OBJECTIVE
To study the pathologic feature of sudden cardiac death in Yunnan province and to investigate the role of myocarditis.


METHODS
During the period from 1991 to 2006, there were 29 cases of sudden cardiac death with autopsy performed. Fourteen of these cases were diagnosed to have myocarditis based on Dallas criteria and World Heart Federation's consensus. The clinical and pathologic findings were reviewed. The cardiac conduction system was examined in details by serial sectioning in 3 cases.


RESULTS
Fourteen cases suffered with myocarditis, which accounted for 48% of all cases of sudden cardiac death studied. The age of the deceased ranged from 8 to 68 years (mean = 30 years), with male-to-female ratio equaled to 9:5. Lymphocytic myocarditis and neutrophil myocarditis were the two major types, affecting 11 and 3 cases, respectively. The inflammatory infiltrates were often patchy rather than diffuse. The inflammatory foci were detected only in 8% to 42% (average = 20%) of the paraffin sections of the heart tissue. These lesions were usually located in the lateral wall of left ventricle and occasionally in interventricular septum and right ventricular wall. Myocardial injury was mild in most cases while patchy myocytolysis or coagulation necrosis was observed only in a few cases. Most of the lesions were relatively new and histologic evidence of myocardial repairing sometimes coexisted. Pericarditis and subacute endocarditis were also identified in 4 and 1 cases, respectively. Atrioventricular node was involved by myocarditis in 1 of the 3 cases examined for cardiac conduction system. Two cases showed gross evidence of cardiac dilatation (either left ventricle or biventricular). Respiratory tract and pulmonary infection was present in 5 cases.


CONCLUSIONS
Myocarditis represents one of the major pathologic changes of sudden cardiac death occurring in Yunnan province. The inflammation is usually focal. Further studies are required for delineation of possible etiologies which may include virus, bacteria or exogenous toxin.
Wang
Hong-Yue
HY
Department of Pathology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. hywangs@hotmail.com
Huang
Wen-Li
WL
Yang
Chong-Fu
CF
Song
Lai-Feng
LF
Zhao
Hong
H
Ren
Jin-Ma
JM
Li
Zhao-Xiang
ZX
Liu
Xiao-Bai
XB
Wang
Yue-Bing
YB
Liu
Ji-Hai
JH
Meng
Xiao-Lin
XL
Shi
Guo-Qing
GQ
Pu
Jie-Lin
JL
Yang
Yue-Jin
YJ
Zeng
Guang
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001283:Atrioventricular Node / Q000473:pathology; D002648:Child; D002681:China / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000473:pathology*; D004108:Dilatation, Pathologic / Q000473:pathology; D004696:Endocarditis / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D010493:Pericarditis / Q000473:pathology