Gross pathology of chronic Chagas cardiomyopathy (four-chamber frontal view).

(A) Cardiomegaly with a left apical aneurysm (arrow). Myocardium hypertrophy. Marked thinning can be noted in the obtuse border of the heart at the submitral area (arrow head). At the apex of the right ventricle, distinct replacement of myocardial tissue by adipose tissue can be seen. (B) Cardiomegaly. Thinning and thrombosis at apices of both ventricles (arrow heads). Dilatation of cardiac ventricular chambers, mainly the right one. Fibrofatty substitution at the apex of the left ventricle and major part of the right ventricular free wall. (C) Normal-sized heart showing an enormous aneurysm at the apex of the left ventricle. Hypertrophy of the right ventricle free wall except for a marked thinned apex can be clearly seen. (D) Mildly enlarged heart showing dilatation of the four chambers. Giant left apical aneurysm. Thinning of left border of the heart immediately below the mitral valve. (E) Globally enlarged chronic chagasic heart with dilatation mainly affecting the right-sided chambers. Adipose replacement of the right ventricular myocardium, particularly at the apical region, associated with bulging can be seen (arrow heads). (F) Transillumination of a chagasic heart showing thinning of the muscle wall “cor bifidum” with aneurysm at the left apex (arrow heads), and marked thinning of the anteroapical region of the right ventricle. RV, right ventricle; LF, left ventricle. All bars = 3 cm.