Pathology of chronic chagas cardiomyopathy in the United States: A detailed review of 13 cardiectomy cases

Evan P. Kransdorf, Mike C. Fishbein, Lawrence S.C. Czer, Jignesh K. Patel, Angela Velleca, Henry D. Tazelaar, R. Raina Roy, D. Eric Steidley, Jon A. Kobashigawa, Daniel J. Luthringer

Research output: Contribution to journalReview article

11 Scopus citations

Abstract

Objectives: The pathologic features of chronic Chagas cardiomyopathy may not be widely appreciated in the United States. We sought to describe the gross, microscopic, immunohistochemical, and molecular pathology features useful to diagnose chronic Chagas cardiomyopathy. Methods: The features from a case series of cardiectomy specimens of patients undergoing heart transplantation (12 patients) or mechanical circulatory support device implantation (one patient) for chronic Chagas cardiomyopathy at three institutions in the United States are reported and analyzed. Results: Gross findings included enlarged and dilated ventricles (100% of cases), mural thrombi (54%), epicardial plaques (42%), and left ventricular aneurysm (36%). Microscopic evaluation revealed myocarditis (100% of cases) characterized by mononuclear cell infiltration, fibrosis (100%), nonnecrotizing granulomas (62%), and giant cells (38%). Two specimens (15%) showed rare intracellular amastigotes. Immunohistochemical assays for Trypanosoma cruzi organisms were negative in all cardiectomy specimens, whereas tissue polymerase chain reaction was positive in six (54%) of 11 cases. Conclusions: The gross and microscopic features of chronic Chagas cardiomyopathy in the United States appear similar to those reported in endemic countries. Importantly, tissue polymerase chain reaction may be useful to confirm the diagnosis.

Original languageEnglish (US)
Pages (from-to)191-198
Number of pages8
JournalAmerican journal of clinical pathology
Volume146
Issue number2
DOIs
StatePublished - Aug 1 2016

Keywords

  • Chagas cardiomyopathy
  • Chagas disease
  • Heart transplantation
  • Surgical pathology
  • Trypanosoma cruzi

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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    Kransdorf, E. P., Fishbein, M. C., Czer, L. S. C., Patel, J. K., Velleca, A., Tazelaar, H. D., Roy, R. R., Steidley, D. E., Kobashigawa, J. A., & Luthringer, D. J. (2016). Pathology of chronic chagas cardiomyopathy in the United States: A detailed review of 13 cardiectomy cases. American journal of clinical pathology, 146(2), 191-198. https://doi.org/10.1093/ajcp/aqw098