Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1979 Dec;54(12):918–930. doi: 10.1136/adc.54.12.918

Coronary arterial lesions and myocardial necrosis in stillbirths and infants.

D J de Sa
PMCID: PMC1545765  PMID: 575283

Abstract

In a detailed study of the coronary arterial tree and myocardium in 256 stillbirths and infants, abnormalities of the coronary arterial tree were noticed in 79 infants, and necrotic lesions of the myocardium in 111 infants. Of the 79 infants with arterial lesions, 70 had associated myocardial necrosis or scarring, or both; the group with coronary arterial lesions, therefore, accounted for the majority of cases with myocardial damage. The myocardial lesions varied from small zones of subendocardial damage, to larger 'geographical' zones of necrosis scattered haphazardly through the myocardium, and a small group where massive necrotic lesions of the papillary muscles were present. While the coronary arterial lesions were associated with all three patterns, they were particularly found in association with the 'geographical' and papillary muscle changes. The coronary arterial lesions varied from zones of acute focal, medial necrosis to severe proliferative intimal lesions and medial defects, with a distinct progression of changes from the acute to the more established lesions. The coronary arterial lesions were seen most commonly in association with conditions that could produce severe hypoxia, and it is argued that they result from hypoxia. It is suggested further that the myocardial damage, so commonly associated with the coronary arterial lesions, could compromise the ability of the hypoxic infant to respond to such an insult. The coronary arterial lesions seen in this group of young infants could offer one explanation for the later development of a variety of other pathological conditions seen in adolescents and young adults.

Full text

PDF
918

Images in this article

919Fig. 1
on p.919
920Fig. 2
on p.920
920Fig. 3
on p.920
921Fig. 4
on p.921
921Fig. 5
on p.921
921Fig. 6
on p.921
922Fig. 7
on p.922
922fig. 8
on p.922
922Fig. 9
on p.922
923Fig. 10
on p.923
923Fig. 11
on p.923
923Fig. 12
on p.923
923Fig. 13
on p.923
924Fig. 14
on p.924
924Fig. 15
on p.924
924Fig. 16
on p.924
924Fig. 17
on p.924
925Fig. 18
on p.925
925Fig. 19
on p.925
925Fig. 20
on p.925
926Fig. 21
on p.926

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allison P. R., Bleehan N., Brown W., Pickering G. W., Robb-Smith A. H., Russell R. P. The production and resolution of hypertensive vascular lesions in the rabbit. Clin Sci. 1967 Aug;33(1):39–51. [PubMed] [Google Scholar]
  2. BURNARD E. D., JAMES L. S. Failure of the heart after undue asphyxia at birth. Pediatrics. 1961 Oct;28:545–565. [PubMed] [Google Scholar]
  3. Berry C. L. Myocardial ischaemia in infancy and childhood. J Clin Pathol. 1967 Jan;20(1):38–41. doi: 10.1136/jcp.20.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bucciarelli R. L., Nelson R. M., Egan E. A., Eitzman D. V., Gessner I. H. Transient tricuspid insufficiency of the newborn: a form of myocardial dysfunction in stressed newborns. Pediatrics. 1977 Mar;59(3):330–337. [PubMed] [Google Scholar]
  5. Cross K. W. Resuscitation of the asphyxiated infant. Br Med Bull. 1966 Jan;22(1):73–78. doi: 10.1093/oxfordjournals.bmb.a070442. [DOI] [PubMed] [Google Scholar]
  6. DeSa D. J., Nicholls S. Haemorrhagic necrosis of the adrenal gland in perinatal infants: a clinico-pathological study. J Pathol. 1972 Mar;106(3):133–149. doi: 10.1002/path.1711060302. [DOI] [PubMed] [Google Scholar]
  7. Esterly J. R., Oppenheimer E. H. Some aspects of cardiac pathology in infancy and childhood. IV. Myocardial and coronary lesions in cardiac malformations. Pediatrics. 1967 Jun;39(6):896–903. [PubMed] [Google Scholar]
  8. Eto T., Onoyama K., Tanaka K., Omae T., Yamamoto T. Early vascular changes in the intestine of bilaterally nephrectomised rats. J Pathol. 1978 Mar;124(3):141–148. doi: 10.1002/path.1711240303. [DOI] [PubMed] [Google Scholar]
  9. Franciosi R. A., Blanc W. A. Myocardial infarcts in infants and children. I. A necropsy study in congenital heart disease. J Pediatr. 1968 Sep;73(3):309–319. doi: 10.1016/s0022-3476(68)80106-4. [DOI] [PubMed] [Google Scholar]
  10. GAULT M. H., USHER R. Coronary thrombosis with myocardial infarction in a newborn infant. Clinical, electrocardiographic and post-mortem findings. N Engl J Med. 1960 Aug 25;263:379–382. doi: 10.1056/NEJM196008252630803. [DOI] [PubMed] [Google Scholar]
  11. GORE I., SMITH J., CLANCY R. Congenital aneurysms of the coronary arteries with report of a case. Circulation. 1959 Feb;19(2):221–227. doi: 10.1161/01.cir.19.2.221. [DOI] [PubMed] [Google Scholar]
  12. GRUENWALD P. Necrosis in the coronary arteries of newborn infants. Am Heart J. 1949 Dec;38(6):889-97, illust. doi: 10.1016/0002-8703(49)90889-3. [DOI] [PubMed] [Google Scholar]
  13. Goldby F. S., Beilin L. J. How an acute rise in arterial pressure damages arterioles. Electron microscopic changes during angiotensin infusion. Cardiovasc Res. 1972 Sep;6(5):569–584. doi: 10.1093/cvr/6.5.569. [DOI] [PubMed] [Google Scholar]
  14. LEVENE C. I. The early lesions of atheroma in the coronary arteries. J Pathol Bacteriol. 1956 Jul;72(1):79–82. [PubMed] [Google Scholar]
  15. LOBER P. H. Pathogenesis of coronary sclerosis. AMA Arch Pathol. 1953 May;55(5):357–383. [PubMed] [Google Scholar]
  16. MOON H. D. Coronary arteries in fetuses, infants, and juveniles. Circulation. 1957 Aug;16(2):263–267. doi: 10.1161/01.cir.16.2.263. [DOI] [PubMed] [Google Scholar]
  17. MacMahon H. E., Dickinson P. C. Occlusive fibroelastosis of coronary arteries in the newborn. Circulation. 1967 Jan;35(1):3–9. doi: 10.1161/01.cir.35.1.3. [DOI] [PubMed] [Google Scholar]
  18. Naeye R. L. Pulmonary arterial abnormalities in the sudden-infant-death syndrome. N Engl J Med. 1973 Nov 29;289(22):1167–1170. doi: 10.1056/NEJM197311292892204. [DOI] [PubMed] [Google Scholar]
  19. ROBERTSON J. H. Stress zones in foetal arteries. J Clin Pathol. 1960 Mar;13:133–139. doi: 10.1136/jcp.13.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rowe R. D., Hoffman T. Transient myocardial ischemia of the newborn infant: a form of severe cardiorespiratory distress in full-term infants. J Pediatr. 1972 Aug;81(2):243–250. doi: 10.1016/s0022-3476(72)80290-7. [DOI] [PubMed] [Google Scholar]
  21. Rowe R. D., Izukawa T., Mulholland H. C., Bloom K. R., Cook D. H., Swyer P. R. Nonstructural heart disease in the newborn. Observations during one year in a perinatal service. Arch Dis Child. 1978 Sep;53(9):726–730. doi: 10.1136/adc.53.9.726. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. SCHORNAGEL H. E. Intimal thickening in the coronary arteries in infants. AMA Arch Pathol. 1956 Dec;62(6):427–432. [PubMed] [Google Scholar]
  23. Salyer W. R., Salyer D. C., Hutchins G. M. Local arterial wall injury caused by thromboemboli. Am J Pathol. 1974 May;75(2):285–300. [PMC free article] [PubMed] [Google Scholar]
  24. Sevitt S. Arterial wall lesions after pulmonary embolism, especially ruptures and aneurysms. J Clin Pathol. 1976 Aug;29(8):665–674. doi: 10.1136/jcp.29.8.665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Tyson J. E., deSa D. J., Moore S. Thromboatheromatous complications of umbilical arterial catheterization in the newborn period. Clinicopathological study. Arch Dis Child. 1976 Oct;51(10):744–754. doi: 10.1136/adc.51.10.744. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Vlodaver Z., Abramovici A., Neufeld H. N., Liban E. Coronary arteries in Yemenites. J Atheroscler Res. 1967 Mar-Apr;7(2):161–170. doi: 10.1016/s0368-1319(67)80078-4. [DOI] [PubMed] [Google Scholar]
  27. WILENS S. L. The nature of diffuse intimal thickening of arteries. Am J Pathol. 1951 Sep-Oct;27(5):825–839. [PMC free article] [PubMed] [Google Scholar]
  28. Whitehead R., Dunnill M. S. Primary dissecting aneurysms of coronary arteries. J Pathol. 1969 Sep;99(1):33–37. doi: 10.1002/path.1710990105. [DOI] [PubMed] [Google Scholar]
  29. Witzleben C. L. Idiopathic infantile arterial calcification--a misnomer? Am J Cardiol. 1970 Sep;26(3):305–309. doi: 10.1016/0002-9149(70)90798-8. [DOI] [PubMed] [Google Scholar]
  30. deSA D. J. Myocardial changes in immature infants requiring prolonged ventilation. Arch Dis Child. 1977 Feb;52(2):138–147. doi: 10.1136/adc.52.2.138. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES