RESUMO
This work is a detailed study of the relevance of three sets of criteria to define myocarditis: Dallas meeting criterion, Edwards criterion and Dallas meeting criterion modified by the authors. Two groups were evaluated: normal autopsied hearts and endomyocardial biopsy from chronic chagasic patients at high risk of having myocarditis. Furthermore, endomyocardial biopsies from patients with dilated cardiomyopathy (DCM) were also evaluated. Applying the Edwards criterion, incidences of myocarditis in normal and chagasic hearts were 0% and 67% while with Dallas meeting criterion they were 0% and 42% and using our criterion the incidences were 0% and 92% respectively. In endomyocardial biopsies from DCM patients, the incidence of myocarditis was 7% with Edwards criterion, 22% with Dallas meeting and 33% with the authors own criterion. The authors concluded that their criterion, which defines myocarditis as the presence of inflammatory mononuclear cells enclosing more than 2 lymphocytes/400X aggregated to the cardiac fiber sarcolemma, is the most appropriate criterion of the three. Myocarditis was found in 33% of the 27 endomyocardial biopsy specimens from patients with DCM.
Assuntos
Cardiomiopatia Dilatada/patologia , Cardiomiopatia Chagásica/patologia , Miocardite/patologia , Miocárdio/patologia , Adulto , Biópsia por Agulha , Doença Crônica , Feminino , Humanos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Miocardite/diagnósticoRESUMO
The authors describe the clinical-pathologic findings in four patients with myocardial infarct (MI) associated with Chagas' disease, found among 181 autopsies of chronic congestive cardiac chagasic patients. Organized thrombo-embolus was found in the epicardial portion of a coronary artery in one instance and thrombosis in the apex of the left ventricle as well as systemic infarcts were found in all cases. These data suggest thrombo-embolism, probably from the apex of the left ventricle, as a possible cause for the regional (large; transmural) MI in chronic Chagas' heart disease. The mechanism usually operative in MI, i.e. complicated atherosclerosis, was not present in the patients of this series. Moreover, our data do not support either small artery disease or heart denervation as etiologic factors for regional MI.
Assuntos
Cardiomiopatia Chagásica/patologia , Miocárdio/patologia , Adulto , Vasos Coronários/patologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/patologia , Tamanho do Órgão , Tromboembolia/patologiaRESUMO
The authors analyze the presence of active myocarditis in endomyocardial biopsies from 38 patients with chronic Chagas' disease diagnosed serologically. The patients were divided into three clinical groups of increasing severity. Group I: 13 patients with normal electrocardiograms, normal chest x-rays, and no symptoms; Group II: 13 patients with abnormal electrocardiograms and no cardiomegaly; and Group III: 12 patients with abnormal electrocardiograms, cardiomegaly and heart failure. In order to diagnose myocarditis activity, two sets of criteria were used: one mainly observing histopathologic aspects of inflammatory cells aggressing cardiac fibers; and the other counting the mean number of lymphocytes per high power microscopic field. The results of both methods showed a higher incidence of active myocarditis in the clinical group with heart failure. The present report clearly shows the important role played by activity of myocarditis in the development of heart failure in chronic Chagas' disease. Therefore, the possibility of using drugs to control early stages of the activity of the inflammatory process is suggested. On the other hand, endomyocardial biopsy (EMB) seems to be an adequate method to evaluate the intensity of the cardiac inflammatory process in Chagas' heart disease.
Assuntos
Cardiomiopatia Chagásica/patologia , Insuficiência Cardíaca/etiologia , Miocárdio/patologia , Adolescente , Adulto , Biópsia , Cardiomiopatia Chagásica/complicações , Doença Crônica , Feminino , Insuficiência Cardíaca/patologia , Humanos , Contagem de Leucócitos , Linfócitos , Masculino , Pessoa de Meia-Idade , Miocardite/complicações , Miocardite/patologiaRESUMO
The case of a five-day-old boy with two "half-hearts," diagnosed at necropsy but not clinically, is presented. Each "half-heart" was totally separated from the other and each had a single atrium and ventricle. The two "half-hearts" were enveloped in a common pericardium. The left-sided atrium and the right-sided atrium had the morphologic characteristics of left and right atrium, respectively, but the morphology of the two ventricles was less characteristic. There were double truncuses and double superior and inferior venae cavae, too. Pulmonary venous drainage was totally anomalous; splenic abnormalities were not found. An embryologic lack of fusion of the primitive cardiac tubes is a possible starting point for these malformations.