Sudden death due to aortic dissection

Abstract

Introduction: Aortic dissection is one of the cardiovascular causes of sudden death; hence deepening into its morphology will help improve diagnosis.

Objective: Clinicopathologic study in cases of sudden death secondary to aortic dissection.

Method: Thirty-four cases of sudden death due to aortic dissection were studied in the histopathology laboratory of the Legal Medicine Institute (1998-2015). Forensic autopsy was performed with complementary histological and toxicological studies.

Results: 73% corresponded to men with a lower average age than women (42 vs. 49 years). The cardiac weight was increased (88%), regardless of age, with a mean of 534 g, and was higher when presenting dilated aortic root (74%) or high blood pressure (53%). Cystic medial degeneration (57%) was associated to aortic dilation (p<0.05) and bicuspid aortic valve, and both with younger age (p=0.001), but not related to high blood pressure and left ventricular hypertrophy in older ages. Horizontal line was more frequent (66%) and Type II DeBakey predominated. Most of them died suddenly at home (66%); 61% from previously known symptoms (51% of the total) was associated with chest pain (mainly precordial). 40% had sought medical attention the day before and were erroneously diagnosed.

Conclusions: Post-mortem study helps to better define the macroscopic and histological characteristics in the most severe cases of aortic dissection to achieve accurate diagnosis.