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Vol. 72. Issue 7.
Pages 553-561 (July 2019)
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Vol. 72. Issue 7.
Pages 553-561 (July 2019)
Original article
DOI: 10.1016/j.rec.2018.07.008
Sudden Death Due to Thoracic Aortic Dissection in Young People: A Multicenter Forensic Study
Muerte súbita por disección de aorta torácica en jóvenes: estudio multicéntrico forense
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Benito Morentin Campilloa, Pilar Molina Aguilarb, Ana Monzó Blascob, José Luis Laborda Gálvezc, Jon Arrieta Péreza, Jennifer Sancho Jiménezb, Julia Lamas Ruiza, Joaquín Lucena Romeroc,
Corresponding author
joaquin.lucena@gmail.com

Corresponding author: Servicio de Patología Forense, Instituto de Medicina Legal y Ciencias Forenses de Sevilla, Miguel Romero Martínez 2, 41015 Sevilla, Spain.
a Servicio de Patología Forense, Instituto Vasco de Medicina Legal y Ciencias Forenses, Bilbao, Vizcaya, Spain
b Servicio de Patología Forense, Instituto de Medicina Legal y Ciencias Forenses, Valencia, Spain
c Servicio de Patología Forense, Instituto de Medicina Legal y Ciencias Forenses, Sevilla, Spain
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Table 1. Distribution of Cases of SD Due to TAD in Individuals Aged 1-35 Years Among All Cases of SCD in Individuals Aged 1 to 35 Years and All Cases of SD Due to TAD at All Ages. Autopsy Data From the Forensic Pathology Services of the Provinces of Biscay, Valencia, and Seville
Table 2. Clinical Data for SD Due to TAD in Individuals Aged 1 to 35 Years (n=35)
Table 3. Demographic, Clinical, and Pathologic Characteristics of Cases of Sudden Death Due to TAD (n=35)
Table 4. Postmortem Findings and Toxicologic Results for SD due to TAD in Individuals Aged 1 to 35 Years (n=35)
Table 5. Main Clinical Characteristics of TAD Series in Individuals Younger Than 35 Years
Table 6. Main Characteristics of Isolated Cases of SD Due to TAD in Individuals Younger Than 35 Years (Autopsy-based Studies)
Table 7. Demographic and Epidemiologic Data in the Main SCD Series Among Individuals Aged 1 to 35 years Compared With the Current Study
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Abstract
Introduction and objectives

Thoracic aortic dissection (TAD) is infrequent in young people and its characteristics differ from those in the adult population. This study aimed to analyze the clinical and pathological characteristics of sudden death due to TAD in people aged 1 to 35 years.

Methods

Multicenter population-based study based on forensic autopsies conducted in the provinces of Biscay (1991-2016), Valencia (2000-2016), and Seville (2004-2016).

Results

We identified 35 individuals with sudden death due to TAD (80% males), with a mean age of 29±5 years. The incidence was 0.09/100 000 inhabitants/y. Eighteen persons had at least 1 risk factor for TAD, and this figure increased to 29 when postmortem findings were included: congenital heart disease (n=16), suspicion of familial TAD (n=11), cocaine use (n=6), and hypertension (n=5). Twenty-four individuals, 12 with at least 1 risk factor, had prodromal symptoms, and 16 of them visited their physician, but TAD was not suspected in any of them. The most frequent symptom was chest pain (n=12). The main autopsy findings were cystic degeneration of the media (n=27), dilatation of the ascending aorta (n=21), cardiac hypertrophy (n=20), and bicuspid aortic valve (n=14).

Conclusions

The incidence of sudden death due to TAD in young people was very low. The most frequent risk factors were congenital heart disease followed by suspicion of familial TAD and cocaine use. TAD should be included in the differential diagnosis of chest pain in young people, mainly male patients with at least 1 risk factor.

Keywords:
Thoracic aortic dissection
Sudden death
Forensic pathology
Autopsy
Youth
Abbreviations:
BAV
CMD
SCD
SD
TAD
Resumen
Introducción y objetivos

La disección de la aorta torácica (DAT) es infrecuente en jóvenes y presenta características diferentes que en la población adulta. En este estudio se analizan las características clinicopatológicas de la muerte súbita por DAT de personas de 1-35 años.

Métodos

Estudio poblacional multicéntrico basado en autopsias forenses realizadas en las provincias de Vizcaya (periodo 1991-2016), Valencia (2000-2016) y Sevilla (2004-2016).

Resultados

Se recogieron 35 casos (el 80% varones), con una media de edad de 29±5 años. La incidencia fue de 0,09/100.000 habitantes/año; 18 sujetos tenían algún factor de riesgo y 29, 1 o más factores de riesgo o hallazgos post mortem asociados con DAT: cardiopatía congénita (n=16), sospecha de DAT familiar (n=11), consumo de cocaína (n=6) e hipertensión arterial (n=5). En 24 casos, 12 con algún factor de riesgo, ya habían presentado síntomas previamente; 16 acudieron al médico, pero nunca hubo sospecha de DAT. El dolor torácico (n=12) fue el síntoma más frecuente. Los hallazgos autópsicos principales fueron: degeneración quística de la media (n=27), dilatación de la aorta ascendente (n=21), cardiomegalia (n=20) y válvula aórtica bicúspide (n=14).

Conclusiones

La incidencia de muerte súbita por DAT fue muy baja. Los factores de riesgo más frecuentes fueron las cardiopatías congénitas, seguidas de la sospecha de DAT familiar y el consumo de cocaína. Se debería incluir la DAT en el diagnóstico diferencial del dolor torácico en jóvenes, principalmente varones, con factores de riesgo asociados.

Palabras clave:
Disección de aorta torácica
Muerte súbita
Patología forense
Autopsia
Jóvenes

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