Corrêa de Araujo R, Bestetti R B, Godoy R A, Oliveira J S
Int J Cardiol. 1985 Dec;9(4):439-55. doi: 10.1016/0167-5273(85)90239-6.
A retrospective study of the medical records filed at the University Hospital from 1965 to 1983 and of 18456 autopsies carried out in the Department of Pathology of this Institution from 1953 to 1983, referring to patients aged less than 18 years was performed in an attempt to fully characterize chronic Chagas' heart disease in children and adolescents. Only 19 of these patients fulfilled the criteria for inclusion in the present study (12 cases with only clinical information and 7 cases with clinical and pathological information). We noted that the clinical manifestations of chronic Chagas' heart disease are congestive heart failure, thromboembolism and sudden death. Radiologic, electrocardiographic and anatomo-pathological findings demonstrated serious myocardial involvement. This set of alterations is also detected in adults with chronic Chagas' heart disease. Among adolescents, however, the disease exhibits relevant peculiarities such as rapid evolution to death within a short period of time (128 days), diagnostic difficulty related to the presence of significant mitral regurgitation (61% erroneous initial diagnosis), and low frequency of right bundle branch block (11% of cases). These findings suggest that among children and adolescents, chronic Chagas' heart disease may be of a peculiar type and therefore may be useful to clarify the pathogenetic mechanism of the disease.
对1965年至1983年存档于大学医院的病历以及1953年至1983年在该机构病理科进行的18456例尸检进行了回顾性研究，这些病历和尸检涉及年龄小于18岁的患者，旨在全面描述儿童和青少年慢性恰加斯心脏病的特征。这些患者中只有19例符合纳入本研究的标准（12例仅有临床信息，7例有临床和病理信息）。我们注意到慢性恰加斯心脏病的临床表现为充血性心力衰竭、血栓栓塞和猝死。放射学、心电图和解剖病理学检查结果显示心肌有严重受累。在患有慢性恰加斯心脏病的成年人中也发现了这一系列改变。然而，在青少年中，该疾病表现出一些相关的特殊之处，如在短时间内（128天）迅速发展至死亡、因存在明显二尖瓣反流导致诊断困难（初始诊断错误率为61%）以及右束支传导阻滞发生率较低（占病例的11%）。这些发现表明，在儿童和青少年中，慢性恰加斯心脏病可能属于一种特殊类型，因此可能有助于阐明该疾病的发病机制。
