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New autopsy rules for mystery deaths

New autopsy rules for mystery deaths

The death of a child is one of the worst experiences a parent can endure, but the pain of that loss is aggravated when the cause remains a mystery.

Now, Ontario has developed a new standard for conducting autopsies in cases of unexplained cardiac death among young people to help identify causes that regular autopsies may miss.

While the new system, developed by the Office of the Chief Coroner for Ontario and the University of Ottawa Heart Institute, will likely provide important answers to grieving families, researchers also hope it will save lives by identifying family members who may be at risk with the same silent, potentially fatal conditions.

"Every month, I see parents who have lost a child and there is one common question, and that is, 'Are my other children at risk of this disease and a similar tragedy?' " said Michael Gollob, director of the Inherited Arrhythmia Clinic and Arrhythmia Research Laboratory at the heart institute. "I think it's readily apparent that this can only help in the care of patients and family members who experience the tragedy of losing a loved one prematurely."

Dr. Gollob said he expects Ontario's model will eventually be adopted across Canada. 

About 100 people aged 18 and under die in Ontario every year as the result of causes that can't be determined by standard autopsies.

In December, 2006, Alex Corrance, 17, a hockey player with the Mississauga Rebels, died during a tournament as the result of an undetected cardiac problem.
Earlier this year, aspiring NHL hockey star and captain of the Ontario Hockey League's Windsor Spitfires, Mickey Renaud, died suddenly at his home. Yesterday , his family said an autopsy determined the 19-year-old died from a heart condition known as hypertrophic cardiomyopathy. 

The condition isn't as rare as some other heart problems that may be more easily missed during standard autopsies, according to Dr. Gollob. Unlike hypertrophic cardiomyopathy, many heart conditions that can kill young people affect the right ventricle (one of four chambers of the heart), which is often overlooked during standard autopsies. The majority of heart problems involve the left ventricle.

Stephen Csatari was 20 when he died suddenly in 2002. Doctors later determined the third-year Queen's University student died of arrhythmogenic right ventricular cardiomyopathy (ARVC), a condition that is often very difficult to recognize during autopsy. 

Since then, his mother, Susan, has campaigned for awareness of the warning signs of such rare heart conditions - such as fainting during exercise or after being startled - with the Canadian Sudden Arrhythmia Death Syndromes Foundation. 

Ms. Csatari said her family was fortunate to have learned the cause of Stephen's death, knowledge they used to help determine whether anyone else in the family was at risk. Clinical tests determined Stephen's father also carried the condition, and he is now on medication to manage the rhythm of his heart. 

The new initiative is a significant development that will likely help other families come to terms with a sudden death and prevent future tragedies, Ms. Csatari said.
"If families are walking around without a diagnosis, someone else in that family is at dire risk of having the same thing happen," said Ms. Csatari, who lives in Mississauga. "It's just a tremendous breakthrough for them."

Ontario's new autopsy standards highlight the need for coroners to examine the right ventricle, as well as other specific measures. 
"This will ensure that all the possible diseases that can be detected by autopsy may be detected," Dr. Gollob said.

The new system will also require corone

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