Ventricular Endomyocardial Fibrosis Research Articles

Endomyocardial disease--clinical features.

The clinical features of tropical and temperate zone endomyocardial fibrosis (EMF) are the same, allowing for certain regional, environmental and possibly genetic variations. For example, the seasonal incidence in rainy humid areas probably reflects the large and repeated parasitic infestations in tropical EMF, while the absence of tissue eosinophilia in organs other than the heart in tropical EMF may reflect racial and environmental differences between tropical and western geographical areas that have still to be elucidated. That EMF occurs in Europeans who have lived in the tropics is undoubted, but the absence of right ventricular involvement in Europeans in the tropics, but not in temperate climes, is unexplained; perhaps it is a chance finding. It is also apparent that the extreme degrees of right ventricular EMF that are commonly seen in the tropics, with almost complete obliteration of the ventricular cavity are not usually seen in eosinophilic EMF in temperate areas. Involvement of both ventricles and of both atrioventricular valves is, however, common both in the tropics and in temperate climate EMF.

Mitral Annuloplasty in Endomyocardial Fibrosis: An Alternative to Valve Replacement

The case of a patient with left ventricular endomyocardial fibrosis (EMF) causing severe mitral regurgitation is presented. Excision of the fibrotic tissue through the left atrium and mitral annuloplasty resulted in symptomatic relief and uncomplicated pregnancy. An X-linked congenital dermatological condition, Bloch-Sulzberger syndrome (incontinentia pigmenti), associated with chronic eosinophilia, was also present. This occurrence with EMF has not previously been reported. Atrioventricular valve reconstruction is a feasible alternative to valve replacement in EMF.

Echocardiography in the diagnosis of right ventricular endomyocardial fibrosis.

Summary Twenty-one patients with endomyocardial fibrosis (EMF) and right ventricular involvement were studied by M-mode echocardiography. All 21 patients showed echocardiographic findings consisting of (i) increased right ventricular dimension, (ii) paradoxical septal motion, (iii) increased right ventricular outflow dimension (iv) thickening of the right ventricular anterior wall with increased right ventricular anterior wall motion, and (v) easily recordable tricuspid valve. In addition, some of the patients had posterior pericardial effusion, and fine fluttering of the tricuspid valve. EMF was diagnosed clinically in all the patients, haemodynamically and angiographically in 15 and confirmed at autopsy in one. None of these echo findings was present in two patients with constrictive pericarditis, and two patients with massive ascites due to portal hypertension.

Right ventricular endomyocardial fibrosis simulating Ebstein's anomaly

A case of right ventricular endomyocardial fibrosis simulating Ebstein's anomaly is described. The clinical features, chest x-ray, electrocardiogram, echocardiogram, intracardiac electrogram, and the angiogram were all compatible with Ebstein's malformation. A correct diagnosis was subsequently made in the operating room. Reasons for the difficulties in the differential diagnoses of these two entities are discussed.

Left ventricular endomyocardial fibrosis in India.

Clinical, radiological, electrocardiographic, haemodynamic, and cineangiographic features of left ventricular endomyocardial fibrosis are described in 8 patients seen during the 10-year period 1965-1975. Exertional dyspnoea was the commonest presenting symptom. Mild to moderate cardiomegaly was often present. The apex beat was never forcible. A loud third heart sound over the apex and an apical early systolic murmur with late systolic decresendo were characteristic of this desease. Chest X-rays films showed left atrial enlargement and pulmonary venous congestion. A pronounced rise in left ventricular end-diastolic pressure, severe pulmonary hypertension, and low cardiac index were seen in 6. Ventriculography showed an irregular, poorly contracting left ventricle with areas of dyskinesis and large end-systolic volume. Mitral regurgitation, when present, was not severe.

CHRONIC PERICARDIAL EFFUSION COMPLICATING ENDOMYOCARDIAL FIBROSIS.

Six patients are described in whom right ventricular endomyocardial fibrosis was accompanied by a large pericardial effusion. This effusion did not appear to modify either the course of the disease or the physical signs, which included gross elevation of the venous pressure, tricuspid incompetence, and massive ascites with complete absence of dependent edema. Atrial fibrillation was a very common finding. Cardiac catheterization confirmed the presence of tricuspid incompetence and showed a "dip-and-plateau" contour in the right ventricular tracing. In addition the mean pressures recorded from the pulmonary artery and all parts of the right heart were virtually the same. Two patients died and were examined postmortem. The findings included gross enlargement of the right atrium, complete disorganization of the tricuspid valve, and progressive obliteration of the right ventricular cavity. It is suggested that death may be due to gradual occlusion of the right atrium by antemortem thrombosis. The condition must be distinguished from tuberculous pericarditis. Important factors in the differential diagnosis are the presence of tricuspid incompetence with systolic expansion of the neck veins, atrial fibrillation, and the demonstration of cardiac enlargement, due to aneurysmal dilatation of the right atrium.