SUDDEN-DEATH FROM CORONARY-ARTERY DISSECTION

Spontaneous dissection of the coronary arteries is an uncommon conditi on that may lead to sudden, fatal coronary artery occlusion. Three cas es of sudden death attributable to coronary artery occlusion are prese nted. Dissection was associated with Marfan's syndrome in the first ca se, and occurred three weeks postpartum in the second case. In case 1, dissection occurred within the intima, and was not associated with an inflammatory cell infiltrate. In cases 2 and 3, dissection occurred b etween the tunica media and the external elastic lamina, and was assoc iated with a mixed inflammatory infiltrate, rich in eosinophils, T lym phocytes, and histiocytes. The spatial limitation of the inflammatory infiltrate to the adventitial compartment, together with the abscence of inflammation in case 1, suggests a reactive origin rather than a ca usative role for the inflammatory cells. Detailed examination of seria l blocks of any coronary artery occlusion is essential in young patien ts.