ABC | Volume 113, Nº2, August 2019

Anatomopathological Correlation Pinesi et al. 26-year-old man with congenital chagas disease and heart transplantation Arq Bras Cardiol. 2019; 113(2):286-293 Figure 6 – Longitudinal section of the explanted heart, showing chamber dilatation and areas of fibrosis in the ventricular septum (arrows). Figure 7 – Detail of the left ventricular tip showing the typical lesion of chronic Chagasic cardiopathy, characterized by myocardial tapering with aneurysm formation (A). Regarding the post-transplant endomyocardial biopsy findings, the presence of inflammation with more than one focus of cardiomyocyte aggression is, at first, compatible with the diagnosis of acute grade 2R cellular rejection. 18 However, as this is the case of a patient with Chagas' disease as the primary cardiopathy, one must carry out a more detailed investigation of parasites, since the histological picture of acute 2R cellular rejection is identical to that of disease reactivation. The investigation was then carried out by immunohistochemistry and then in more detailed sections of the biopsy block, we concluded it was a reactivation of Chagas' disease in the transplanted heart, which allowed the appropriate treatment to be implemented. It is known that the rate of reactivation depends on the implemented immunosuppressive treatment, as previously described. The work of Vidal et al. 19 also showed that the first episode of reactivation occurred at a median of 6.6 months post-transplantation. Therefore, the routine evaluation of endomyocardial biopsies in Chagasic patients with heart transplantation should include, whenever there is an R2 or higher grade acute cellular rejection, a very detailed evaluation of the histological sections for possible detection of parasites. (Dr. Vera Demarchi Aiello) 291