title: Pathology of Chronic Chagas Cardiomyopathy in the United States:  A Detailed Review of 13 Cardiectomy Cases.
abstract: OBJECTIVE
  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.
authors.affiliation: From the Division of Cardiovascular Diseases.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Kransdorf
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA.
authors.forename: Mike C
authors.initials: MC
authors.lastname: Fishbein
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Lawrence S C
authors.initials: LS
authors.lastname: Czer
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Jignesh K
authors.initials: JK
authors.lastname: Patel
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Angela
authors.initials: A
authors.lastname: Velleca
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ.
authors.forename: Henry D
authors.initials: HD
authors.lastname: Tazelaar
authors.affiliation: Department of Cardiology, Maricopa Integrated Health System, Phoenix, AZ.
authors.forename: R Raina
authors.initials: RR
authors.lastname: Roy
authors.affiliation: From the Division of Cardiovascular Diseases.
authors.forename: D Eric
authors.initials: DE
authors.lastname: Steidley
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
authors.affiliation: Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Luthringer
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D002598:Chagas Cardiomyopathy / Q000382:microbiology / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014481:United States
keywords: Chagas cardiomyopathy; Chagas disease; Heart transplantation; Surgical pathology; Trypanosoma cruzi