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Anomalies of coronary number and course represent an opinion-dividing topic in cardiopathology, particularly for their relationship with sudden cardiac death.To the best of our knowledge, we herein report the first fatal case of a young female whose coronary anatomy was characterised by the absence of any septal perforator branch in the proximal segment of the LAD.This case could be useful for pathologists, coronary angiographers, and interventional cardiologists in detecting this infrequent anomaly, thus providing a more accurate estimation of its incidence., Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3570015858473043.

Congenital coronary anomalies represent a condition often unrecognized in the living and in the dead. Investigating this condition is relevant for both clinicians and pathologists in order to identify potentially unrecognized coronary causes of sudden death. Hypoplastic coronary artery disease (HCAD) is a rare congenital abnormality reported to be associated with sudden death. We report two additional cases of previously apparently healthy people who died suddenly and were found to have HCAD at postmortem evaluation. The clinicopathologic findings are discussed along with a review of the literature.

We report a rare case of ostial plication as a potential cause of sudden death. Very few reports and images are available in the specialized literature regarding this anomaly. Ostial plication may be a source of sudden death or cause of death when no other significant autopsy findings are present.Ostial plication is a congenital severe obstruction/occlusion of the right or left ostium. Plication of the aortic wall leads to a "valve-like" ridge that can act as a door blocking inflow during diastolic filling, with consequent ischemia and a potentially life-threatening arrhythmia. The true incidence of this condition and its relationship to sudden death have not been reported in the literature. We believe that this case will be useful to autopsy pathologists in detecting this infrequent anomaly, thus providing a more accurate estimation of its incidence.

Background: T-lymphocyte activation within atherosclerotic plaque, and widespread to the myocardium, has been shown in patients with acute coronary syndromes., Objective: To investigate the presence of T-lymphocyte infiltrate at different stages of acute coronary syndromes by studying patients with sudden coronary death, acute myocardial infarction (AMI) and healed infarction, in comparison with patients with myocarditis and patients with non-ischaemic heart failure., Methods: 72 cases were studied at autopsy: 12 dying of sudden coronary death (group 1), 12 dying <4 weeks (group 2) and 12 dying >4 months after AMI (group 3), 12 with active lymphocytic myocarditis (group 4), 12 with hypertensive heart disease (group 5), and 12 control subjects (group 6). Light microscopy was performed to measure the number of activated T-lymphocytes (CD3+/DR+) in the myocardium and coronary artery wall, and intercellular adhesion molecule-1 (ICAM-1) expression in the myocardium., Results: Activated T-lymphocyte infiltrates and ICAM-1 myocardial expression in both remote and peri-infarction regions and activated T-lymphocytes within the epicardial coronary artery wall of both the infarct- and non-infarct-related arteries were found in groups 1, 2 and 3, whereas myocardial, but not coronary, infiltrates were found in groups 4 (p<0.001 vs groups 1, 2 and 3 for coronary infiltrates). Groups 5 and 6 had no evidence of myocardial or coronary inflammation (p<0.001 vs groups 1, 2 and 3)., Conclusions: The study shows the presence of a lymphocytic infiltrate in both coronary arteries and myocardium and a proinflammatory phenotype shift in the myocardium associated with acute coronary thrombosis in patients dying suddenly, shortly, or even late after coronary thrombosis.

Coronary atherosclerosis is responsible for >50% of all cases of sudden death and for 90% of sudden coronary death. Four cases encountered in routine autopsy evaluation at our institute in 2004 in which non-atherosclerotic coronary pathology was responsible for sudden cardiac death are reported. The cases of a 31-year-old man with epicardial coronary arteritis, a 57-year-old man with intramyocardial vasculitis, a 45-year-old woman with spontaneous coronary dissection and a 50-year-old man with vascular fibrosis are described. Searching for non-atherosclerotic coronary disease is relevant for both the clinician and the pathologist to prevent coronary causes of sudden death going unrecognised.