[Histologic correlation of ischemic and chagasic ventricular aneurysms. Relation to physiopathology].

We depict the histologic findings of ventricular aneurysms in 8 patients, 5 with Chagas heart disease and 3 secondary to myocardial infarction. Chagas disease and ischemic cardiopathy are the 2 conditions which show the highest incidence of ventricular aneurysms. The first one averages more than 60% in large series. The second one reveals ventricular aneurysms as a complication of myocardial infarction in 20-25% in large series. Both entities share identical hallmarks, and the same frequency of complications related to the presence of the aneurysms: vgr. sudden death, presence of malignant ventricular arrhythmias, thromboembolism, etc. Several histologic findings help to differentiate both conditions. Inflammatory cells, monocytes, eosinophils and lymphocytes interspersed within myocardial fibers, plus diverse lesions of myocytolysis point to a diagnosis of Chagas disease. We consider scar fibrosis as another capital difference to be observed in aneurysms of chagasic or ischemic origin. Fibrosis of ischemic origin is intense and early depending upon a quick stimulation of collagen I and III during the first days of myocardial infarction. Conversely, in Chagas disease the injury to the myofibrils by immunocomplexes is very slow and consequently collagen response will be slower and with lesser fibrotic response. We have previously considered in other publications this phenomenon after a geometrical-dynamical model have been designed for this purpose.