Critical coronary artery ostial narrowing and sudden death

Coronary ostial stenosis is an uncommon lesion but one that may be associated with significant and potentially lethal reduction in distal artery blood flow. While most commonly due to atherosclerosis, it may also be caused by aortic arteritis, congenital webs or post-surgical complications following aortic valve replacement. Three cases of lethal ischemic heart disease are reported where occult ostial narrowing/occlusion was first identified at autopsy. Case 1: A 70-year-old man with hypoplasia of the right coronary artery and tunneling of the left anterior descending coronary artery had atherosclerotic obliteration of the right coronary artery ostium. Cases 2 & 3: Two men (aged 80 and 85 years respectively) with marked epicardial coronary artery atherosclerosis also had associated atherosclerotic obliteration of their right coronary artery ostia. Examination of the coronary ostia is an important part of the forensic assessment in cases of sudden death, as isolated occlusive lesions may be the only explanation for a lethal episode. In other cases, as in those reported herein, ostial stenosis/occlusion may be an additional contributing factor to global myocardial ischemia from coronary artery atheroma and/or other causes.