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The aims of this study were to assess if dystrophin can be a tool for the forensic evaluation of sudden cardiac death due to coronary atherosclerotic disease (CAD) and particularly if it can be a marker of early myocardial ischaemia. Then in this investigation, the dystrophin was compared to C5b-9 and fibronectin to analyze if there are some differences in the expression of these proteins. Two groups of CAD-related sudden cardiac death, respectively the group 1 with gross and/or histological evidence and the group 2 with no specific histological signs of myocardial ischaemia were used. A third group formed by cases of acute mechanical asphyxiation was used as a control. The immunohistochemical staining by dystrophin, C5b-9 and fibronectin antibodies was performed. Loss of sarcolemmal dystrophin was observed in different degrees according to more or less significant histological evidence of myocardial ischaemia. Moreover, the comparison between loss of dystrophin expression and fibronectin positivity showed significant differences in group 2. The results suggested that dystrophin can be used in forensic diagnosis of CAD-related sudden cardiac death and as marker of early myocardial ischaemia. [ABSTRACT FROM AUTHOR]

Takotsubo cardiomyopathy, also known as 'broken heart syndrome,' is a cardiac entity characterized by transient left ventricular dysfunction without obstructive atherosclerotic coronary artery disease. An episode of emotional stress is believed to act as a trigger in the development of this syndrome, which typically occurs in female patients. We report a fatal case of a previously healthy 70-year-old woman who suffered an out-of-hospital cardiac arrest and cardiac rupture during emotional distress, due to Takotsubo cardiomyopathy. Ventricular rupture with Takotsubo cardiomyopathy is rare, but our case emphasizes the importance of dealing with this serious and potentially life-threatening disease. Takotsubo cardiomyopathy should be considered as a differential diagnosis in cases of early-developing heart failure, and clinicians should subsequently use adequate diagnostic and therapeutic options. [ABSTRACT FROM AUTHOR]

Incomplete Kawasaki disease (IKD) and atypical Kawasaki disease (AKD) represent rare conditions. Two cases of unexpected or sudden infant death are reported. The diagnosis for a 3-month-old girl was determined by echocardiography, and the child unexpectedly died despite appropriate treatment, whereas autopsy determined the diagnosis of AKD for a 4-month-old boy. In both patients, giant coronary artery aneurysms with thrombosis and vasculitis, myocarditis, and coagulative necrosis were shown at autopsy. These rare forms of IKD and AKD carry a poor prognosis and represent a paradox between the severe cardiovascular damage and the clinical presentation that mimics common and usually self-limiting exanthematic infectious disease in infancy. [ABSTRACT FROM AUTHOR]

Abstract: The arterial switch operation (ASO) has become the surgical treatment of choice for transposition of the great arteries (TGA). Myocardial ischemia owing to coronary complication remains the commonest cause of mortality and morbidity following ASO. The main clinical manifestations of coronary obstruction reported after a switch procedure are heart failure, arrhythmias, or sudden death. Coronary complications are responsible for about 50% of early death and for almost all late deaths. We describe pathologic and anatomic findings in two cases of late sudden death after an ASO. Critical intimal thickening and acute take-off of coronary trunks were the main pathological substrates of death. Histological examination revealed an obstructive coronary proliferation characterised by a concentric stratum of intimal smooth muscle cell hyperplasia with preserved tunica media. Pathogenetic assessment of intimal coronary lesions after an ASO should consider the role of endothelium and vascular parietal wall in the unavoidable response to injury caused by arterial reconstruction. Since a rapidly progressive proliferative disease is suspected, to explain coronary narrowing, understanding endothelial biology and improving surgical technique should help to prevent late coronary events. [Copyright &y& Elsevier]