Unsuspected cardiac lesions associated with sudden unexpected perioperative death

The retrospective analysis of 1700 forensic autopsies over 17 years (1981-9 7) following unexpected sudden cardiac death revealed a group of 50 cases t hat could have been related to surgery and/or anaesthesia. Patients were yo ung with no history of cardiac disease. Surgery was performed for uncomplic ated disorders, all classified as ASA 1. Cardiac arrest took place at induc tion of anaesthesia in 16% of cases, during surgery in 64% and at the end o f 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 lesio ns in 47 cases: arrhythmogenic right ventricular cardiomyopathy in 18 cases , coronary artery disease in 10 cases, cardiomyopathy in eight cases, struc tural 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.