ABC | Volume 111, Nº1, July 2018

Case Report Atik et al. Mechanical circulatory support in Chagas cardiomyopathy Arq Bras Cardiol. 2018; 111(1):112-114 Figure 1 – Chest radiography after ECLS implantation. Figure 2 – Chest radiography after left ventricular assist device implantation. Discussion The present report illustrates that, in patients with Chagas cardiomyopathy with severe biventricular failure, a left ventricular assist device (and not necessarily a biventricular support) may be considered as a modality of mechanical circulatory support as a bridge to candidacy or transplantation. Frequent pathologic findings that need to be observed are apical aneurysms, mural thrombi, very thin ventricular walls and complex ventricular arrhythmias refractory to ablation. Destination therapy, in theory, is a possible alternative for those patients that do not present with late right heart failure, which is a possible natural manifestation of the disease. Since published data is very limited and the experience with mechanical circulatory support in Latin America is scarce, there are no consensus regarding the best strategy. Moreira et al were the first to report the use of paracorporeal devices in Chagas cardiomyopathy, with inconsistent results. 6 More recently, Kransdorf et al 7 reported the United States experience on 11 heart transplants for Chagas cardiomyopathy. Three out of 11 patients (27%) had mechanical circulatory support in place at the time of transplant (two patients had paracorporeal devices in biventricular configuration and one patient had a HeartMate II device). Ruzza et al 8 described the successful support with a total artificial heart prior to heart transplantation. They argue that this approach is justifiable because it allows treatment of extracardiac Chagas disease, and it potentially reduces the infectious burden of the causative organism that may make progress the disease on a heart supported with a device. 113