title: Sudden death after major head and neck cancer surgery due to undetected arrhythmogenic right ventricle cardiomyopathy (ARVC).
abstract: BACKGROUND
  Oral squamous cell carcinoma is the sixth most frequent malignancy in Austria. The incidence of arrhythmogenic right ventricle dysplasia (ARVC), an important cause of sudden cardiac death, is estimated at 1:5000 to 1:1000.
  
  
  METHODS
  We present a case of a 75-year-old woman who underwent major oncologic surgery for T4aN0M0 maxillary squamous cell carcinoma and reconstruction with a scapular-latissimus dorsi microvascular flap. The patient died suddenly during her postoperative care. Autopsy revealed pericardiac tamponade due to rupture of the right ventricular wall. Histologic examination showed ARVC in a sample taken directly from the ruptured area. Cause of death was secondary arrhythmia originating from the ARVC. The arrhythmia had led to rupture of the right ventricular wall and sudden cardiac death.
  
  
  CONCLUSIONS
  As per our current knowledge, no cases of maxillary cancer and ARVC as co-morbidities have been reported in the literature. The patient had been given anti-arrhythmia treatment for previously detected atrial fibrillation, which could have been why the arrhythmia was not apparent on the electrocardiogram. Thus, although the appropriate preoperative diagnostics were performed according to current oncologic and anesthesiology guidelines, the potentially lethal cardiac condition of the patient could not be detected.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum Wels-Grieskirchen, 42 Grieskirchnerstrasse, Wels, Austria. akos.bicsak@gmail.com.
authors.forename: Ákos
authors.initials: Á
authors.lastname: Bicsák
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum Wels-Grieskirchen, 42 Grieskirchnerstrasse, Wels, Austria.
authors.forename: Alice
authors.initials: A
authors.lastname: Jellen
authors.affiliation: Department of Pathology, Klinikum Wels-Grieskirchen, 42 Grieskirchnerstrasse, Wels, 4600, Austria.
authors.forename: Herwig
authors.initials: H
authors.lastname: Tuppy
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum Wels-Grieskirchen, 42 Grieskirchnerstrasse, Wels, Austria.
authors.forename: Wolfgang Paul
authors.initials: WP
authors.lastname: Poeschl
mesh_terms: D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D058752:Free Tissue Flaps / Q000601:surgery; D006341:Heart Rupture / Q000209:etiology / Q000473:pathology; D006801:Humans; D008441:Maxillary Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*
keywords: ARVC; Arrhythmogenic right ventricle cardiomyopathy; Major head and neck cancer surgery; Oral squamous cell carcinoma; Scapular-latissimus dorsi microvascular free flap; Sudden cardiac death