[The heart conduction system in the chronic trypanosomal myocarditis (preliminary communication)].
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An attempt has been made to demonstrate morphological equivalents of electrocardiographically determined conduction disturbances in the human heart. In 50% of our cases an authentic morphological change was found. In 25% the correlation remained doubtful, and in another 25% there was no connection. The highest coincidence was found in chronic left bundle branch block and in dissecting aneurysms causing hemopericardium. The correlation between function and morphology is very loose in patients who have undergone cardiac surgery. Etiology is discussed only marginally; ischemia is the predominant feature.
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Disorders of the genesis and conduction of impulses in different parts of the cardiac conduction system are the result of functional or morphological damage of parts of the conduction system. Pathological processes which affect the cardiac conduction system are practically always comprehensive and ensue from the character of the basic disease. Previous embryological and histological investigations provide evidence of developmental and structural similarity of all portions of the cardiac conduction system. On this fact the assumption of a similar reaction of the conduction system to the acting pathological process is based. In a group of 127 patients with a positive finding, on invasive examination of the conduction system in 57 (45%) a pathological process was detected at several levels of the conduction system. This finding is consistent with experience reported in the literature and supports the justification of the term "disease of the cardiac conduction system" when there is evidence of multi-focal damage of the conduction system.
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Feasibility and degree of local AV junction destruction were studied prior to the induction of complete transversal block on the model of 18 isolated perfused dog hearts, using endoscopic laser device, employing cardiofibroscope and laser Ne: YAG. Morphological pattern in the destruction zone is presented. The technique and device can be used for transvenous AV junction destruction.
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Although mice infected with Trypanosoma cruzi develop a wide variety of electrocardiographic (ECG) alterations, the typical isolated right bundle branch block or its association with the left anterior hemiblock patterns are not found in this model. This has been explained as related to topographic differences in the anatomy of the murine conducting system. However, there is no conclusive evidence that the murine conducting system differs from the human system. In this study, the anatomy of the murine conducting system is described, as well as its involvement in the chronic stages of experimental infection. 24 three-month-old C3H mice were infected with 50 bloodstream forms of T. cruzi, Tulahuén strain. Animals were killed after 3, 8 and 12 months. Whole frontal sections of the heart, including the conducting system, were serially studied. The sinoatrial node was located in the right atrial appendage, or in the junction between the superior vena cava and the right atrium, or "riding" on the interatrial septum. The atrioventricular (A-V) node and the His bundle showed a similar anatomic course to that in man. Therefore, there was no important anatomical difference that might have explained the lack of the ECG patterns observed in human chagasic myocardiopathy. The inflammatory involvement and the lesions of the conducting system were diverse and rarely severe. No significant difference was observed in animals killed at different times. The lesions in the working myocardium were similar to those observed in humans (chronic inflammatory infiltrates). Nevertheless, the topography of lesions was different: there was a selective involvement in the neighbourhood of the A-V groove.(ABSTRACT TRUNCATED AT 250 WORDS)
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A systemic quantitative electron microscopic analysis on innervation of the sinus node, the atrioventricular node, the bundle of His and its pedicles within the interventricular septum has been performed in intact hearts of mature rats. The data have been obtained on the size of nonmyelinated and myelinated nerve fibres, efferent and afferent terminals within different parts of the cardiac conductive system, their interconnection with specialized cardiomyocytes have been described. Application of certain methods for electron microscopic investigation on the innervation of mammalian cardiac conductive system has been discussed.