1/43. Chronic Chagas' heart disease in a Japanese-Brazilian traveler. A case report. A 57-year-old Japanese-Brazilian man, visiting japan for only 9 days, was admitted to our hospital due to syncope and frequent ventricular premature beats. He grew up in a rural area of brazil and moved to Sao Paulo in 1959 when he was 20 years old. We suspected chronic Chagas' heart disease, i.e., dilated cardiomyopathy with apical ventricular aneurysm, right bundle branch block with left anterior fascicular block, and various arrhythmias including supraventricular premature beats, ventricular premature beats and non-sustained ventricular tachycardia because he showed typical echo- and electrocardiographic features of the disease. Coronary arteriograms were normal, and left ventriculogram confirmed the existence of apical ventricular aneurysm. A left ventricle biopsy specimen showed hypertrophic cardiac muscle with mild fibrosis. The diagnosis of chronic Chagas' disease was finally confirmed by the demonstration of trypanosoma cruzi itself in the blood as well as trypanosoma cruzi antibodies. ( info) |
2/43. histoplasmosis as a late infectious complication following heart transplantation in a patient with Chagas' disease. Infectious complications following heart transplantation are an important cause of morbidity and mortality. Generally, bacterial infections are predominant; however, fungal infections can be responsible for up to 25% of infectious events. We report the case of a patient who presented with histoplasmosis as an infectious complication five years after heart transplantation due to a chagasic cardiopathy. This association has rarely been reported in the international literature. ( info) |
| The authors report four cases of acute chagasic myocarditis which had been diagnosed and treated in Cayenne, french guiana, in the past 6 years. This French territory, which has the highest standard of living in south america, should be considered an area of risk for sporadic chagas disease with epidemiologic features similar to those of the disease found in dense Amazon forest areas. Appropriate measures must be taken to screen and promptly manage chagas disease in the french guiana population. ( info) |
4/43. Improved left ventricular contraction and energetics in a patient with Chagas' disease undergoing partial left ventriculectomy. A 43-year-old patient with heart failure, precluded from heart transplantation or dynamic cardiomyoplasty because of Chagas' disease cardiomyopathy, mitral regurgitation, and ventricular mural thrombi, underwent mitral valvuloplasty and partial left ventriculectomy (PLV) between the papillary muscles. Intraoperative pressure-volume relationship analyses suggested improvement in left ventricular contraction, energetics, isovolumic relaxation, and mitral valve competency. These improvements allowed prompt, short-term recovery despite unchanged myocardial pathology, which suggests that a surgical approach can alter anatomic-geometric factors and achieve clinical improvement in a dilated failing ventricle. ( info) |
5/43. Radiofrequency ablation of sustained ventricular tachycardia related to the mitral isthmus in Chagas' disease. This case report describes the electrophysiological findings of a 62-year-old patient with chronic Chagas' disease and two distinct morphologies of sustained ventricular tachycardia that involved a mitral isthmus. Multiple RF applications were necessary to obtain a bidirectional conduction block in the mitral isthmus that was related to the interruption of both tachycardias. After the procedure, the patient presented massive cerebral infarction that progressed to coma and death. autopsy showed acute and old lesions at the mitral isthmus and recent mitral annulus thrombosis. ( info) |
6/43. Analysis of the presence of trypanosoma cruzi in the heart tissue of three patients with chronic Chagas' heart disease. It is still unclear to what extent myocarditis-associated, chronic Chagas' heart disease is due to persisting trypanosoma cruzi. In the present study, we have analyzed tissue samples from the hearts of three patients with this disease. in situ hybridization provided little evidence for the presence of intact T. cruzi even at sites of strong inflammation. Nevertheless, micromanipulation techniques detected remnants of both T. cruzi kinetoplast dna and nuclear dna. trypanosoma cruzi dna was also detected in single macrophages dissected directly from frozen heart tissue sections. Thus, this analysis demonstrates that T. cruzi kinetoplast dna and nuclear dna are widely dispersed in the heart tissue, although in low amounts. Since we rarely detected intact T. cruzi parasites during the chronic phase of Chagas' heart disease, we can exclude heart tissue as a major parasite reservoir. ( info) |
| We report the first case of bone marrow cell transplantation to the myocardium of a patient with heart failure due to chagas' disease. The patient is a 52-year-old man with chronic heart failure, NYHA functional class III, despite the optimized clinical therapy. The procedure consisted of aspiration of 50 mL of bone marrow through puncture of the iliac crest, followed by filtration, separation of the mononuclear cells, resuspension, and intracoronary injection. The left ventricular ejection fraction at rest, measured using radionuclide ventriculography with labeled red blood cells prior to transplantation, was 24%, and, after 30 days, it increased to 32% with no change in the medicamentous schedule. The following measurements were assessed before and 30 days after transplantation: left ventricular end diastolic diameter (82 mm and 76 mm, respectively); minnesota living with heart failure questionaire score (55 and 06, respectively); and distance walked in the 6-minute walking test (513 m and 683 m, respectively). Our findings show that intracoronary injection of bone marrow cells may be performed, suggesting that this is a potentially safe and effective procedure in patients with due to Chagas' disease heart failure. ( info) |
8/43. Reactivation of cardiac Chagas' disease in acquired immune deficiency syndrome. We report the case of a 29-year-old man who developed acute congestive heart failure secondary to cardiac Chagas' disease in the setting of trypanosoma cruzi reactivation by acquired immune deficiency syndrome. ( info) |
9/43. trypanosoma cruzi myocardial infection reactivation presenting as complete atrioventricular block in a Chagas' heart transplant recipient. A 56-year-old man underwent orthotopic heart transplantation because of end-stage Chagas' cardiomyopathy. One hundred and ten days following heart transplantation, an electrocardiogram tracing showed complete atrioventricular block, which was treated with temporary transvenous pacemaker insertion. An underlying endomyocardial biopsy was graded 3A. The patient was treated with pulse steroid therapy. One week later, the patient died of multiorgan failure secondary to septicemia. A careful review of the endomyocardial biopsy showed nests of parasites in the myocardial tissue accompanied by mononuclear cell infiltrate similar to that found in acute graft rejection. Thus, complete atrioventricular block may be another clinical manifestation of trypanosoma cruzi infection reactivation in Chagas' heart transplant recipients. ( info) |
10/43. Left ventricular malposition of pacemaker lead in Chagas' disease. A 52-year-old Argentinian woman presented with third-degree AV block due to seropositive chronic stage of Chagas' disease. Subsequently, a DDD pacemaker was implanted. Interestingly, a postoperative chest X ray suggested left ventricular lead misplacement, an ECG showed a paced RBBB. echocardiography confirmed suspected lead malposition in the left ventricle with perforation of a large aneurysm of the interatrial septum that might be related to Chagas' disease. The ventricular lead was successfully repositioned in the right ventricle. Therefore, to avoid lead malposition in Chagas' disease structural cardiac defects should always be ruled out before operation. If a paced RBBB indicates malposition, different fluoroscopic projections should be used to verify lead position. ( info) |