窦房结病理性纤维化的研究进展

人类心脏节律主要受窦房结调控,纤维化对窦房结起搏复合体的结构和功能完整性有重要调节作用。在生理状态下,窦房结中纤维化的量与心率呈负相关,与年龄、心脏大小呈正相关,并可维持心率相对稳定。窦房结病理性纤维化可能导致不同类型的心律失常引起猝死。明确窦房结病理性纤维化相关机制将为临床治疗窦房结纤维化提供靶点,也可为法医病理学工作者提供诊断依据。本文回顾了窦房结病理性纤维化的主要机制,包括窦房结内心脏成纤维细胞异常激活、心外膜脂肪组织增生、钙钟紊乱、血管狭窄等,介绍其检验方法、诊断标准及在心脏性猝死中的作用,探讨其潜在的应用领域,为相关研究、应用提供参考。     

窦房结、房室连接区出血猝死一例

窦房结、房室连接区出血猝死一例林少影，姚青松，谢细红，彭汝标（海南医学院法医组；海口５７０００５广州市刑事技术研究所；广州５１００００海南省公安厅；海口５７０００５）间质性肺炎合并心脏传导系统的窦房结尾部、房室连接区、房室束左束支起始部出血引起猝死，...     

青壮年猝死综合征窦房结肽能神经支配的定量分析

目的研究青壮年猝死综合征(SMDS)窦房结肽能神经的分布及其比例关系,探讨SMDS的猝死机制。方法采用LSAB免疫组化方法结合计算机图象分析技术,对12例非心性死亡者及6例SMDS窦房结进行神经肽Y(NPY)、血管活性肠肽(VIP)的免疫组化染色并作定量分析。结果SMDS组与非心性死亡组相比,窦房结NPY、VIP免疫阳性物含量及VIP/NPY两者比值均无显著性差异。结论SMDS的猝死机制可能与心脏自主神经功能失调无明显相关。     

窦房结动脉高度狭窄致猝死二例

心脏冠状动脉的病变往往可导致猝死，但由窦房结动脉单纯狭窄引起的摔死尚很少有，现报告两例如下。实例资料例1．20岁，男性，民工。领工资后购好回家乡的火车票，准备第二天回故里，当天上午10时突然晕倒，当医生赶到抢救时，发现已死亡。例223岁，男性，民工。某日晚饭后，到蕉林偷香蕉，被人发现并追赶，奔跑中突然倒地死亡。以上两例尸检检查见指、趾甲明显紫错，尸斑暗红色，分布于背侧未受压部位。体表均未见明显损伤。解剖见各脏器淤血，未见致死病变。常规取材进行组织学检查，脑、肝、脾、肺、肾等器官均未见明显病理变化，但见心…     

PKC在青壮年猝死综合征心肌组织中的变化

目的探讨蛋白激酶C（PKC）与青壮年猝死综合征之间的关系。方法取30例青壮年猝死综合征、20例正常对照心脏标本的左右心室肌、窦房结、房室结组织,通过免疫组化学染色,应用图像分析软件对PKC分布及强度变化进行定量检测分析,并进行统计学处理。结果青壮年猝死者心肌细胞PKC平均灰度值及面积代数和显著高于正常对照组（P〈0.05）;其中青壮年猝死者窦房结中的PKC平均灰度值大于房室结（P〈0.05）。结论PKC作为体液调节的途径之一,参与青壮年猝死发病过程,并起到保护性作用。PKC可以作为诊断青壮年猝死的一项参考指标。     

心包膜炎侵犯心传导系统致猝死两例报告

<正> 心包炎是心性猝死原因之一,通常仅考虑心包炎猝死是积液过多、过速,心脏受压或缩窄性心包炎心脏舒张障碍,致使心功不全猝死,作者在对猝死病例作心传导系统常规检查中,发现两例心包炎侵及窦房结而发生猝死,现报导如下。     

一种简便的心脏传导系统检查法

<正> 心脏传导系统包括窦房结、房室结、房室束(His 束)、左右束支及其末稍等部分。其中窦房结和房室结是起搏的主要成分。猝死常与窦房结、房室结、房室束和束支结构异常或病变有关,尤以窦房结和房室结更为重要。半个世纪以来,国内外检查心传导系统的传统方法,主要是与其长轴方向垂直切取若干块组织,作连续切片,每例需检查数百甚至     

小冠状动脉疾病合并冠状动脉畸形尸检1例

1案例某男，26岁，干部，某日上午被发现死于床上，现场勘验未发现异常情况。尸检：死者面、唇紫绀，体表无损伤。心脏重350g，心腔轻度扩张，左心室厚1.3cm，右心室厚0.3cm．心瓣膜未见异常；左、右冠状动脉开口处高出主动脉瓣缘0．3cm；右冠状动脉旁有一副冠状动脉；冠状动脉右优势型分布；窦房结动脉起始段外径0.05cm，结动脉来自右冠状动脉;冠状动脉主支未见粥样硬化斑。显微镜下见多处心肌壁内小冠状动脉壁纤维性增厚，管腔狭窄；心肌细胞浊肿、波状变性及嗜酸变性；部分心肌萎缩、肥大及间质纤维化；窦房结内肌细胞减少及脂肪浸润。肺…     

先天性二叶型主动脉瓣狭窄猝死1例

主动脉瓣狭窄是一种较常见的心脏瓣膜疾病,常由先天畸形和后天性疾病所致,严重者常发生猝死。文献曾有钙化性主动脉瓣狭窄的报告,但先天性二叶型主动脉瓣狭窄较少见。现报告先天性二叶型主动脉瓣狭窄引起猝死 1例。 1案例 　　某女, 40岁。某日因债务纠纷与他人争吵,在相互撕扯中袁某向前走了几步倒地死亡。家属怀疑死亡系外伤所致,遂提出要进行法医学鉴定。死者生前曾患"风心病"。 2尸检 　　死后 48h尸检。死者身长 158cm,发育正常,营养中等。尸斑暗红色,分布于尸体背部未受压部位。体表未见损伤。尸体剖验见双肺淤血,心脏明显…     

HSP70在青壮年猝死综合征心肌组织中的变化

目的探讨热休克蛋白70（HSP70）在青壮年猝死综合征形成机制中的作用,及其早期诊断作用。方法取30例青壮年猝死、20例正常对照心脏标本的左右心室肌、窦房结、房室结组织,通过免疫组化学染色,应用图像分析软件对HSP70分布及强度变化进行定量检测分析,并进行统计学处理。结果青壮年猝死者心肌传导系统内HSP70表达高于正常对照组,且具有统计学意义（P〈0.05）。其中青壮年猝死者右心室肌HSP70的表达显著低于其他部位心肌组织（P〈0.05）。结论HSP70作为一种应激反应的介质参与青壮年猝死综合征的发生过程,并对心脏起到保护性作用。HSP70可作为青壮年猝死综合征诊断的参考指标。     

Poor results in attempting to demonstrate the cause of death by examination of the conduction system of the heart in cases of sudden death

A microscopic examination of the proximal part of the conduction system in the heart was undertaken in seven cases of sudden death due to coronary arteriosclerosis; the same technique was applied to 31 control cases. A few infiltrations of mononuclear cells were demonstrated in relation to the conduction system in cases of sudden death as well as in controls. In one case severe narrowing of the sinus node artery was found without particular arteriosclerosis of the coronary arteries.     

Sudden Death Caused by Anomalous Origin of the Coronary Artery During Exercise

Anomalous origin of the coronary artery (AOCA) is a rare, but important cause of sudden cardiac death among young athletes. Nine autopsy cases (8 male, 1 female; mean age, 17.9 years; age range, 11–31 years) of sudden death during or just after exercise caused by AOCA were reviewed. The exercises performed at the time of death were running (4 cases), soccer (2 cases), and baseball, swimming and kendo (Japanese swordsmanship) (1 case each). In 6 cases, the left coronary artery arose from the right sinus of Valsalva, and in 3, the right coronary artery from the left sinus. The coronary arteries passed between the pulmonary artery and the aorta with an acute angle takeoff from the orifice. Three cases had cardiovascular manifestations prior to death. In cases with cardiovascular manifestations, novel imaging methods should be considered to prevent sudden death.     

Sudden death and anomalous origin of the coronary arteries from the aorta. A case report and review

Based on a case report of sudden death in a young boy, this paper reviews the available information concerning the various combinations of anomalous origins of coronary arteries and associated sudden death. Left coronary arteries arising from the right sinus of Valsalva and passing between the aorta and pulmonary arteries are often associated with sudden death and myocardial ischemia in young people. Although right coronary arteries originating from the left sinus of Valsalva and passing between the aorta and pulmonary artery are less frequently associated with symptoms, this condition may be associated with sudden death. The incidence of symptoms associated with other anomalous origins is also discussed.     

Sudden infant death with anomalous origin of the left coronary artery.

Autopsy of a 3-month-old girl, an apparent case of sudden infant death syndrome, revealed anomalous origin of the left coronary artery from the right aortic sinus. Acute angulation of the left coronary artery along the aortic root, as well as a focal intramyocardial course within the ventricular septum, may have contributed to episodic luminal narrowing. Anomalous coronary origins of similar type have been associated with sudden death in children, teenagers, and young adults, but have not necessarily been associated with sudden death in older adults. Somewhat similar malformations have been reported in sudden infant death; two cases involved the left coronary artery and six involved the right.     

Histologic findings of the sinus node and the perinodal area in street heroin addicts, victims of sudden unexpected death

Sudden unexpected death is frequent in street heroin addicts. We conducted a histologic study of the sinus node (SN) to offer some evidence about the possible arrhythmogenic cause of death. Postmortem coronary angiography and microscopic examination of the SN and the perinodal area were performed in 50 heroin addicts (group 1) and in 50 nonaddicts (group 2), all men (16-40 years old). In heroin addicts, fatty and/or fibrous tissue replaced SN tissue in 21 cases (42%). Perinodal infiltration was found in 15 cases (30%). Fibromuscular dysplasia in branches of the sinus node artery (SNA) was found in eight cases (16%). Inflammation with focal and/or diffuse concentration of round cells was detected in the SN in 22 cases (44%). Old mural thrombi were also found in 13 cases (26%). The histologic changes in the SN and perinodal area offer an explanation about the possible mechanism of arrhythmia and sudden death in this population.     

Circumflex artery from the right coronary sinus: a not-so-benign anomaly

The origin of the circumflex coronary artery from the right sinus of Valsalva is generally considered a benign anomaly. Herein we report the sudden unexpected death of a 6-year-old boy who died after jumping into a swimming pool and whose only pathologic finding was this usually inconsequential coronary artery anomaly. A discussion of the pathophysiology of the disorder and a literature review are included. This is the youngest patient to die with this entity.     

Subendocardial small infarct in the superior ventricular septum as a cause of sudden death

In autopsy files from April 1999 to April 2001, five cases showed macroscopic subendocardial small infarct above 1 cm diameter in the superior ventricular septum (SVS) near the atrioventricular (AV) junction, and all five were finally considered to be sudden cardiac death after full investigation. All these small infarcts in these Japanese patients were located at the posterior site of the SVS, an area mainly nourished by branches which ramified from the AV node artery and which branched from the right coronary artery (RCA). Four of the five showed acute (A) or subacute (SA) foci in or around the healed (H) lesion and surviving myocytes were visible in infarcts, in all cases, which suggested a recurrent or chronic prolonged ischemia in the territory. Four of the five had a significant stenosis of the RCA and in the other one, there was an anomalous origin of the RCA. As all five had also small artery disease in the SVS, small infarct of the posterior SVS may have formed by hemodynamic impairment in the territory of the AV node artery caused by RCA disorders. We consider the evidence of macroscopic small infarct of the posterior SVS greatly aids in determining the cause of sudden death in forensic autopsy and may be notable lesion for discussing the pathogenesis of sudden cardiac death with RCA disorder.     

房室结纤维和脂肪增多与房室结动脉狭窄的关系

目的探讨房室结纤维、脂肪含量与房室结动脉狭窄之间的关系,分析房室结内病理性纤维化和病理性脂肪浸润的原因。方法选取119例心源性猝死案例,用Image-pro plus图像分析软件检测组织切片,计算房室结面积,房室结动脉内径、房室结动脉管腔面积(lumen area,LA)、外周横截面积(perimeterarea,PA),纤维组织面积和脂肪组织面积。将所有案例分为动脉狭窄组和正常对照组组,观察房室结动脉PA/LA值及房室结纤维及脂肪含量的改变。结果狭窄组房室结动脉PA/LA值在21～40岁最大,40岁以下两组房室结脂肪含量和总间质含量差异有统计学意义。结论房室结动脉狭窄与房室结间质含量增多有一定关系。     

Sudden death caused by coronary artery aneurysms: a late complication of Kawasaki disease

The authors describe three cases (two blacks and one Latin American) of sudden death caused by late complications of Kawasaki disease (mucocutaneous lymph node syndrome). At autopsy each heart contained multiple coronary artery aneurysms with luminal stenosis caused by intimal hyperplasia and thrombi. Although virtually all fatal cases of Kawasaki disease occur within six months of the onset of symptoms, there have been other reported deaths up to 14 years after the acute illness. The coronary artery aneurysms of Kawasaki disease may persist and cause death years after the acute illness.