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Unsuspected cardiac lesions associated with sudden unexpected perioperative death

Published online by Cambridge University Press:  16 August 2006

A. Tabib
Affiliation:
Department of Pathology, L. Pradel Hospital, BP Lyon Montchat, 69394 Lyon, Cedex 03, France
R. Loire
Affiliation:
Department of Pathology, L. Pradel Hospital, BP Lyon Montchat, 69394 Lyon, Cedex 03, France
A. Miras
Affiliation:
Institute for Forensic Medicine, 14 Avenue Rockefeller, 69008 Lyon, Cedex 03, France
F. Thivolet-Bejui
Affiliation:
Department of Pathology, L. Pradel Hospital, BP Lyon Montchat, 69394 Lyon, Cedex 03, France
Q. Timour
Affiliation:
Department of Medical Pharmacology, 8 Avenue Rockefeller, 69373 Lyon, Cedex 03, France
B. Bui-Xuan
Affiliation:
Department of Anaesthesia and Intensive Care, E. Herriot Hospital, 5 Place Arsonval, 69437 Lyon, Cedex 03, France
D. Malicier
Affiliation:
Institute for Forensic Medicine, 14 Avenue Rockefeller, 69008 Lyon, Cedex 03, France
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Abstract

The retrospective analysis of 1700 forensic autopsies over 17 years (1981–97) following unexpected sudden cardiac death revealed a group of 50 cases that could have been related to surgery and/or anaesthesia. Patients were young with no history of cardiac disease. Surgery was performed for uncomplicated disorders, all classified as ASA 1. Cardiac arrest took place at induction of anaesthesia in 16% of cases, during surgery in 64% and at the end of surgery in 20%. Investigation and expertise reports ordered by the public prosecutor revealed none of the typical causes of death usually associated with surgery or anaesthesia. Pathological examination showed cardiac lesions in 47 cases: arrhythmogenic right ventricular cardiomyopathy in 18 cases, coronary artery disease in 10 cases, cardiomyopathy in eight cases, structural abnormalities of the His bundle in nine cases, mitral valve prolapse in one case, and acute myocarditis in one case. Identification of the cause of death of patients at low risk may provide major relief to the family of the patient and the medical staff.

Type
Original Article
Copyright
2000 European Society of Anaesthesiology

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