A Pediatric Series of Sudden Death and Congenital Coronary Artery Anomalies

Coronary artery anomalies (CAAs) are rare but critical contributors to sudden cardiac death (SCD) in young individuals. This study reviews 12 cases from the statewide Utah medical examiner system over 33 years, including 4 infants, 2 children aged 3 years, and 6 adolescents (12 to 19 y). Autopsies revealed various CAAs: 3 cases with arteries originating from the pulmonary circulation, 6 cases with anomalous origins between the aorta and pulmonary trunk, 2 cases with ostial displacement and stenosis, and 1 case with abnormal anterior coronary formation. Of the 11 cases where histology was performed, 8 of them showed acute or chronic myocardial ischemia. Notably, 5 of 6 adolescents collapsed during physical exertion, highlighting the role of stress in triggering fatal events. This series underscores the importance of recognizing CAAs as a significant cause of SCD in young individuals, often in the absence of prior cardiac symptoms. Accurate identification of these anomalies at autopsy is crucial for understanding and preventing future tragic outcomes. With thorough exams and descriptive reports by the forensic pathologists, this information can enhance awareness and aid clinicians in early detection and intervention in living children, potentially reducing the incidence of unexplained sudden deaths.