Throughout the cardiac conduction system of each heart there were numerous destructive lesions including focal inflammatory infiltration with lymphocytes and in neighboring regions extensive focal fibrotic degeneration. These lesions involved myocytes, nerves and blood vessels. They were adequate explanation for the familiar disturbances in cardiac rhythm and conduction typical of Chagasic cardiomyopathy. In one heart there was a left ventricular apical aneurysm, which is often considered typical of Chagasic cardiomyopathy. To our surprise, virtually every myocyte in the region of the aneurysm was undergoing extensive dehiscence, thus severing all intercellular junctions of the involved myocytes. Therefore, we suggest that the left ventricular apical aneurysms represent a form of disuse atrophy produced by the sympathetic denervation caused by neuropathology in the intertruncal plexus of each heart. Sympathetic innervation of virtually the entire left ventricle is derived from nerves supplied through ganglia in the intertruncal plexus. The random nature of the neuropathology in the intertruncal plexus is the probable explanation of why some Chagasic hearts exhibit generalized Chagasic cardiomyopathy, while others have a more restricted denervation ending in left ventricular apical aneurysms. Perhaps the most intriguing finding in our study was the abundance of flagellated trypanosoma cruzi within the intertruncal plexus of each heart. The trypanosomes were often in clusters, sometimes encysted by a thin fibrous membrane, but more often in loose aggregates without a surrounding membrane. Some trypanosomes were seen boring into intertruncal nerves while others formed dense clusters of trypanosomes attached to the outer surface of an intertruncal vein. We believe that these observations have seldom, if ever, been described before, and they represent interesting opportunities in future diagnosis and treatment of cardiac disease caused by trypanosoma cruzi.

中文翻译：

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突然死亡的恰加斯病患者的肌间神经丛和心脏传导系统的事后研究。

在每个心脏的整个心脏传导系统中，有许多破坏性病变，包括淋巴细胞的局灶性炎症浸润，并且在邻近区域广泛发生局灶性纤维变性。这些病变累及肌细胞，神经和血管。它们足以说明Chagasic心肌病典型的心律和传导异常。在一个心脏中，存在左室心尖动脉瘤，通常被认为是典型的Chagasic型心肌病。令我们惊讶的是，实际上，动脉瘤区域中的每个心肌细胞都经历了广泛的裂开，从而切断了受累心肌细胞的所有细胞间连接。因此，我们建议，左心室心尖动脉瘤代表一种废弃的萎缩，这种萎缩是由每个心脏的肌间神经丛中的神经病理学引起的交感神经支配产生的。实际上，整个左心室的交感神经支配来自于跨神经丛神经节所提供的神经。腰间神经丛神经病理学的随机性，可能解释了为什么一些南美锥虫性心脏表现为全身性南美锥虫性心肌病，而另一些则更受神经支配，而终止于左心室根尖动脉瘤。也许在我们的研究中，最有趣的发现是每个心脏的肌间神经丛内有大量的鞭毛克氏锥虫。锥虫通常成簇，有时被薄的纤维膜所包裹，但更常见的是散装的聚集体，没有周围的膜。观察到一些锥虫钻进了椎间神经，而另一些锥虫则形成了密集的锥虫簇，附着在椎间静脉的外表面。我们相信这些观察很少（如果有的话）曾经被描述过，它们代表了未来诊断和治疗克氏锥虫引起的心脏病的有趣机会。