Forensic pathological analysis of sudden cardiac death in 10 cases with congenital coronary ostial stenosis: a...

Sudden cardiac death (SCD) caused by congenital coronary ostial stenosis (CCOS) remains underrecognized in forensic practice due to its rarity and the diagnostic challenges. This report presents 10 autopsy-confirmed cases of CCOS-related SCD, aiming to illustrate their characteristic manifestations, pathophysiological mechanisms, and key forensic identification criteria. A systematic literature review was conducted to contextualize our findings within existing evidence. Definitive diagnosis of CCOS requires a multidisciplinary approach, integrating death scene investigation, complete autopsy (including whole-heart dissection), histopathological validation (H&E staining), and rigorous exclusion of other causes of death. Quantitative analysis showed 7 cases (70%) had right coronary artery ostial (RCO) stenosis, 1 case (10%) had left coronary artery ostial (LCO) stenosis, and 2 cases (20%) had bilateral stenosis, with 4 cases (40%) presenting obstructive fibrous membranes. This study emphasizes the necessity of a standardized anatomical protocol for coronary ostial assessment, particularly transverse sectioning at 2 mm intervals starting from the aortic sinus. These findings aim to prompt forensic pathologists to incorporate specialized coronary ostial evaluation into routine autopsy procedures, thereby reducing diagnostic omissions in sudden unexpected death investigations.