Endomyocardial biopsy in Chagas' heart disease
pathogenetic contributions
Keywords:
Endomyocardial biopsy, Chagas' disease, Pathogenesis, Trypanosoma cruzi, ImmunopathologyAbstract
Endomyocardial biopsy procedure has been performed in many centers around the world, allowing a better treatment and follow up of the patients with myocardial disease. In Chagas' disease, it has been performed in São Paulo Heart Institute since 1978 and has brought important contributions to the understanding of the disease and consequently of the patient's clinical stage. In the present work we summarize the principal findings regarding the pathogenesis of Chagas' disease obtained mainly from the studies using endomyocardial biopsy specimens. Nowadays we do not have doubts that the inflammatory infiltrate aggressing myocardial fibers has fundamental role in the progression of the myocardial damage in Chagas' disease what culminates in chronic heart failure. The parasite seems to have active participation in the maintenance of such myocardial inflammation.
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References
. BRITO, T. - Miocardite "alérgica" do cobaio e sua possível relação com a cardite chagásica experimental São Paulo, 1962 [Tese Doutoramento - Universidade de São Paulo]
CARRASCO GUERRA, H.A.; PALÁCIOS-PRÜ, E.; SCORZA, C.D.; MOLINA, C.; INGLESSIS, G. & MENDOZA, R.V. - Clinical, histochemical and ultrastructural correlation in septal endomyocardial biopsies from chronic chagasic patients: Detection of early myocardial damage. Am Heart J 113:716-24, 1987.
COSSIO, P.M.; DIEZ, D.; SZARFMAN, A. & ARANA, R.M. - Chagasic cardiopathy. Demonstration of a serum gamma globulin factor which reacts with endocardium and vascular structures. Circulation 49: 13-21, 1974.
FRANCO, M.F. - Experimental carditis induced by Trypanosoma cruzi (Y strain) in guinea pigs: correlation between histopathology and the presence of T cruzi antigens identified by indirect immunofluorescence. Rev Soc Bras Med Trop 23:187-89, 1990.
HIGUCHI, M.L.; BRITO, T.; REIS, M.M. et al. - Correlation between Trypanosoma cruzi parasitism and myocardial inflammatory infiltrate in human chronic chagasic myocarditis. Light microscopy and immunohistochemical findings. Cardiovasc Pathol 2:101-6, 1993.
HIGUCHI, M.L.; DE MORAIS, C.F.; PEREIRA-BARRETO, A.C. et al. - The role of active myocarditis in the development of heart failure in chronic Chagas' disease: a study based on endomyocardial biopsies. Clin Cardiol 10:665-70, 1987.
HIGUCHI, M.L.; GUTIERREZ, P.S.; AIELLO, V.D. et al. - Immunohistochemical characterization of infiltrating cells in human chronic chagasic myocarditis: comparison with myocardial rejection process. Virchows Archiv A Pathol Anat 423:157-60, 1993.
HIGUCHI, M.L.; LOPES, E.A.; SALDANHA, L.B. et al. - Immunopathologic studies in myocardial biopsies of patients with Chagas' disease and idiopathic cardiomyopathy. Rev Inst Med Trop São Paulo 28: 87-90, 1986.
KOBERLE, F. - Cardiopatia chagásica. Hospital (Rio de Janeiro) 53: 311-46, 1958.
KONNO, S. & SAKAKIBARA, S. - Endomyocardial biopsy. Dis Chest 44:345-50, 1963.
LOPES, E.R.; CHAPADEIRO, E.; ALMEIDA, H.O. & ROCHA, A. - Contribuição ao estudo da anatomia patológica dos corações de chagásicos falecidos subitamente. Rev Soc Bras Med Trop 6: 269-82, 1975.
MADY, C.; PEREIRA, A.; STOLF, N. et al. - Right ventricular endomyocardial biopsy in undetermined form of Chagas' disease. Angiology 35:755-8, 1984.
MAGARINO-TORRES, C.B. - Patogenia de la miocardite cronica de la "enfermedad de Chagas". Quinta Reunión de la Sociedad Argentina de Patologia Regional do Norte 2: 902-16, 1929.
MOLINA, H.A.; MILEI, J. & STORINO, R. - Chronic Chagas' myocardiopathy. Demonstration of in vivo bound immunoglobulins in heart structures by the immunoperoxidase technique. Cardiology 71:297-306, 1984.
MUNIZ, J. & AZEVEDO, A.P. - Novo conceito da patogenia da Doença de Chagas. Hospital (Rio de Janeiro) 32: 165-83, 1977.
PALÁCIOS-PRÜ, E.; CARRASCO, H.; SCORZA, C. & ESPINOZA, R. - Ultrastructural characteristics of different stages of human chagasic myocarditis. Am J Trop Med Hyg 4: 29-40, 1989.
PEREIRA-BARRETO, A.C.; COSTA, R.; HIGUCHI, M.L. et al. - Biópsia endomiocárdica do ventrículo direito - 9 anos (1978-1987). Arq Bras Cardiol 49: 147-9, 1987.
PEREIRA-BARRETO, A.C.; MADY, C.; ARTEAGA-FERNANDEZ, E. et al. - Right ventricular endomyocardial biopsy in chronic Chagas' disease. Am Heart J 111:307-12, 1986.
STOLF, N.A.; HIGUCHI, M.L.; BOCCHI, E. et al. - Heart transplantation in patients with Chagas' disease cardiomyopathy. J Heart Transpl 6:307-12, 1987.
SZTEIN, M.; WASHINGTON, R.C. & KIERSZENBAUM, F. - Trypanosoma cruzi inhibits the expression of CD3, CD4, CD8 and IL-2R by mitogen-activated helper and cytotoxic-human lymphocytes. J Immunol 144: 3558-62, 1990.
TEIXEIRA, A.R.L.; TEIXEIRA, M.L. & SANTOS BUCH, C.A. - The immunology of experimental Chagas' disease. IV. Production of lesions in rabbits similar to those of chronic Chagas'disease in man. Am J Path 80: 163-180, 1975.