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Reithmann C, Kling T, Metani M, Klingel K, Ulbrich M. Endomyocardial substrate of ventricular arrhythmias in patients with autoimmune rheumatic diseases. J Cardiovasc Electrophysiol 2023; 34:1850-1858. [PMID: 37554105 DOI: 10.1111/jce.16036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Delayed enhancement-magnetic resonance imaging (DE-MRI) has demonstrated that nonischemic cardiomyopathy is mainly characterized by intramural or epicardial fibrosis whereas global endomyocardial fibrosis suggests cardiac involvement in autoimmune rheumatic diseases or amyloidosis. Conduction disorders and sudden cardiac death are important manifestations of autoimmune rheumatic diseases with cardiac involvement but the substrates of ventricular arrhythmias in autoimmune rheumatic diseases have not been fully elucidated. METHODS AND RESULTS 20 patients with autoimmune rheumatic diseases presenting with ventricular tachycardia (VT) (n = 11) or frequent ventricular extrasystoles (n = 9) underwent DE-MRI and/or endocardial electroanatomical mapping of the left ventricle (LV). Ten patients with autoimmune rheumatic diseases underwent VT ablation. Global endomyocardial fibrosis without myocardial thickening and unrelated to coronary territories was detected by DE-MRI or electroanatomical voltage mapping in 9 of 20 patients with autoimmune rheumatic diseases. In the other patients with autoimmune rheumatic diseases, limited regions of predominantly epicardial (n = 4) and intramyocardial (n = 5) fibrosis or only minimal fibrosis (n = 2) were found using DE-MRI. Endocardial low-amplitude diastolic potentials and pre-systolic Purkinje or fascicular potentials, mostly within fibrotic areas, were identified as the targets of successful VT ablation in 7 of 10 patients with autoimmune rheumatic diseases. CONCLUSION Global endomyocardial fibrosis can be a tool to diagnose severe cardiac involvement in autoimmune rheumatic diseases and may serve as the substrate of ventricular arrhythmias in a substantial part of patients.
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Affiliation(s)
- Christopher Reithmann
- Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, München, Germany
| | - Theresia Kling
- Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, München, Germany
| | - Manjola Metani
- Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, München, Germany
| | - Karin Klingel
- Department of Kardiopathologie, Institut für Pathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Michael Ulbrich
- Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, München, Germany
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Anbarasu M, Krishna Manohar SR, Titus T, Neelakandhan KS. One-and-a-Half Ventricle Repair for Right Ventricular Endomyocardial Fibrosis. Asian Cardiovasc Thorac Ann 2016; 12:363-5. [PMID: 15585710 DOI: 10.1177/021849230401200418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One-and-a-half ventricle repair, consisting of endocardiectomy with tricuspid valve replacement and bidirectional cavopulmonary shunt, was performed on a patient with right ventricular endomyocardial fibrosis and right ventricular outflow tract obstruction. The patient made a smooth recovery. We believe that this repair provides good palliation for a subset of patients with right ventricular endomyocardial fibrosis.
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Affiliation(s)
- Mohanraj Anbarasu
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India
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Grimaldi A, Ammirati E, Karam N, Vermi AC, de Concilio A, Trucco G, Aloi F, Arioli F, Figini F, Ferrarello S, Sacco FM, Grottola R, D'Arbela PG, Alfieri O, Marijon E, Freers J, Mirabel M. Cardiac surgery for patients with heart failure due to structural heart disease in Uganda: access to surgery and outcomes. Cardiovasc J Afr 2014; 25:204-11. [PMID: 25073490 PMCID: PMC4241599 DOI: 10.5830/cvja-2014-034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/13/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes. METHODS We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography. RESULTS Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31%) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60%), followed by RHD (16 patients, 32%). RHD was the main cause of HF (30%) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86%, median age 19 years (IQR: 12-31)] and in 36 patients with CHD [88%, median age 4 years (IQR 1-5)]. Twenty-seven candidates (32%) were operated on after a median waiting time of 10 months (IQR 6-21). Sixteen (19%) had died after a median of 38 months (IQR 5-52); 19 (22%) were lost to follow up. CONCLUSION RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.
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Affiliation(s)
- Antonio Grimaldi
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy.
| | - Enrico Ammirati
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy
| | - Nicole Karam
- Paris Cardiovascular Research Centre, INSERM U970, Paris, France
| | - Anna Chiara Vermi
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy
| | | | - Giorgio Trucco
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda
| | - Francesco Aloi
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda
| | - Francesco Arioli
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy
| | - Filippo Figini
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy
| | - Santo Ferrarello
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy
| | - Francesco Maria Sacco
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy
| | | | | | - Ottavio Alfieri
- Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy
| | - Eloi Marijon
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Paris Cardiovascular Research Centre, INSERM U970, Paris, France
| | - Juergen Freers
- Division of Cardiology, Department of Medicine, Makerere University, Kampala, Uganda
| | - Mariana Mirabel
- St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Paris Cardiovascular Research Centre, INSERM U970, Paris, France
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Grimaldi A, Alfieri O, Camici PG, La Canna G, Zoppei G, Olivotto I. ["African sickness" and the heart: the mystery of endomyocardial fibrosis]. G Ital Cardiol (Rome) 2011; 12:484-491. [PMID: 21779114 DOI: 10.1714/915.10074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The epidemic of cardiovascular disease is a global phenomenon and the magnitude of its increase in incidence and prevalence in low-income countries has potentially major implications for those high-income countries that characterize the developed world. The "epidemiologic transition" provides a useful framework for understanding changes in the patterns of disease as a result of socioeconomic and demographic developments. According to the migratory flow, the burden of African immigrants in Italy is rising, and there is a need to re-assess the clinical management of anything but obsolete western cardiovascular disorders also delving into the rare tropical neglected diseases. Rheumatic fever and tropical cardiac diseases, such as endomyocardial fibrosis in Africa and Chagas disease in Latin America, require a human resource framework to direct into research and intervention programs. This review will focus upon endomyocardial fibrosis, by far the most common type of restrictive cardiomyopathy worldwide, still an unsolved puzzle from a pathophysiological point of view and in need of more attention from the international community of cardiologists. In this paper the data from the literature are implemented by our personal experience at the St. Raphael of St. Francis Hospital-Nsambya and the Ugandan Heart Institute of Kampala, the capital town of Uganda.
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Affiliation(s)
- Antonio Grimaldi
- Dipartimento Cardio-Toraco-Vascolare, Universita Vita-Salute, Milano, Italy.
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Salemi VMC, Fernandes F, Sirvente R, Nastari L, Rosa LV, Ferreira CA, Pena JLB, Picard MH, Mady C. Does quantitative left ventricular regional wall motion change after fibrous tissue resection in endomyocardial fibrosis? Clinics (Sao Paulo) 2009; 64:17-22. [PMID: 19142546 PMCID: PMC2671969 DOI: 10.1590/s1807-59322009000100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 09/15/2008] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES We compared left ventricular regional wall motion, the global left ventricular ejection fraction, and the New York Heart Association functional class pre- and postoperatively. INTRODUCTION Endomyocardial fibrosis is characterized by fibrous tissue deposition in the endomyocardium of the apex and/or inflow tract of one or both ventricles. Although left ventricular global systolic function is preserved, patients exhibit wall motion abnormalities in the apical and inferoapical regions. Fibrous tissue resection in New York Heart Association FC III and IV endomyocardial fibrosis patients has been shown to decrease morbidity and mortality. METHODS We prospectively studied 30 patients (20 female, 30+/-10 years) before and 5+/-8 months after surgery. The left ventricular ejection fraction was determined using the area-length method. Regional left ventricular motion was measured by the centerline method. Five left ventricular segments were analyzed pre- and postoperatively. Abnormality was expressed in units of standard deviation from the mean motion in a normal reference population. RESULTS Left ventricular wall motion in the five regions did not differ between pre- and postoperative measurements. Additionally, the left ventricular ejection fraction did not change after surgery (0.45+/-0.13% x 0.43+/-0.12% pre- and postoperatively, respectively). The New York Heart Association functional class improved to class I in 40% and class II in 43% of patients postoperatively (p<0.05). CONCLUSIONS Although endomyocardial fibrosis patients have improved clinical symptoms after surgery, the global left ventricular ejection fraction and regional wall motion in these patients do not change. This finding suggests that other explanations, such as improvements in diastolic function, may be operational.
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Affiliation(s)
- Vera Maria Cury Salemi
- Cardiomyopathy Unit, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
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Vaidyanathan K, Agarwal R, Sahayaraj A, Sankar M, Cherian KM. Endomyocardial fibrosis mimicking Ebstein's anomaly: a diagnostic challenge. Tex Heart Inst J 2009; 36:250-251. [PMID: 19568399 PMCID: PMC2696495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Endomyocardial fibrosis is a rare disease that is seen most commonly in tropical countries. It usually presents with characteristics of right-heart failure. Herein, we report the case of a 14-year-old adolescent boy who experienced endomyocardial fibrosis. Upon transthoracic echocardiography, the condition was mistakenly diagnosed as Ebstein's anomaly of the tricuspid valve. Sixteen months after undergoing tricuspid annuloplasty and receiving a bidirectional Glenn shunt, the patient showed no echocardiographic evidence of valvular regurgitation. We discuss imaging and surgical techniques that enable the diagnosis and treatment of endomyocardial fibrosis.
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Affiliation(s)
- Karthik Vaidyanathan
- Department of Cardiac Surgery, Frontier Lifeline, Dr. KM Cherian Heart Foundation, Chennai 600101, India.
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Mocumbi AO, Sidi D, Vouhe P, Yacoub M. An innovative technique for the relief of right ventricular trabecular cavity obliteration in endomyocardial fibrosis. J Thorac Cardiovasc Surg 2007; 134:1070-2. [PMID: 17903544 DOI: 10.1016/j.jtcvs.2007.04.062] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 04/20/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Ana Olga Mocumbi
- Imperial College, London, United Kingdom, and Instituto do Coração, Maputo, Mozambique
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Korczyk D, Taylor G, McAlistair H, May S, Coverdale A, Gibbs H, Ruygrok P. Heart Transplantation in a Patient with Endomyocardial Fibrosis Due to Hypereosinophilic Syndrome. Transplantation 2007; 83:514-6. [PMID: 17318086 DOI: 10.1097/01.tp.0000251385.71296.27] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Idiopathic hypereosinophilic syndrome (HES), a systemic disease that commonly involves the heart leading to progressive endomyocardial fibrosis, frequently manifests as restrictive cardiomyopathy. In this report, we describe the first case of a patient with endomyocardial fibrosis due to HES who underwent orthotopic heart transplantation at our institution. A literature review and discussion are included.
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Affiliation(s)
- Dariusz Korczyk
- New Zealand Heart and Lung Transplant Service, Auckland City Hospital, New Zealand.
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Bestetti RB, Theodoropoulos TAD, Burdmann EA, Santos MA, Abbud-Filho M. Switch from cyclosporine to sirolimus as a treatment of acute renal failure complicating cardiogenic shock in a heart transplant recipient. Int J Cardiol 2006; 112:e83-4. [PMID: 16916552 DOI: 10.1016/j.ijcard.2006.03.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 03/25/2006] [Indexed: 11/25/2022]
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Cherian SM, Jagannath BR, Nayar S, Cherian KM. Successful reoperation after 17 years in a case of endomyocardial fibrosis. Ann Thorac Surg 2006; 82:1115-7. [PMID: 16928558 DOI: 10.1016/j.athoracsur.2005.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Revised: 11/16/2005] [Accepted: 12/08/2005] [Indexed: 11/18/2022]
Abstract
Endomyocardial fibrosis is an uncommon cause of congestive cardiac failure characterized by severe diffuse thickening of the endocardium, and the overall long-term prognosis of this disease is generally considered poor. We report a case of endomyocardial fibrosis that was initially treated by endocardial resection and mitral valve replacement, which was regularly followed-up. The patient underwent successful repair of a paravalvular leak after a period of 17 years. The treatment of left ventricular endomyocardial fibrosis with associated mitral valve disease by endocardial resection and mitral valve replacement is a good surgical option that provides good long-term results.
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Affiliation(s)
- Sanjay Mammen Cherian
- Department of Cardiovascular Surgery, Frontier Lifeline, International Centre for Cardiothoracic and Vascular Diseases & Dr KM Cherian Heart Foundation, Chennai, India
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Affiliation(s)
- Humberto F G de Freitas
- Unidade de Transplante Cardíaco e Insuficiência Cardiaca, Instituto do Coração - InCor - HC - FMUSP.
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Affiliation(s)
- Ricardo C Cury
- Department of Radiology, Massachusetts General Hospital, 100 Charles River Plaza, Ste 400, Boston, MA 02114, USA.
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Souza LCG, Carvalho KATD, Rebelatto C, Senegaglia A, Furuta M, Miyague N, Hansen P, Francisco JC, Olandowski M, Brofman PRS. Combined transplantation of skeletal myoblasts and mesenchymal cells (cocultivation) in ventricular dysfunction after myocardial infarction. Arq Bras Cardiol 2004; 83:294-9; 288-93. [PMID: 15517043 DOI: 10.1590/s0066-782x2004001600004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Cell therapy in the myocardium has been mainly performed with satisfactory results using 2 cell types: skeletal myoblasts (myogenic) and mesenchymal cells (angiogenic). This study assessed the combined transplantation of those 2 cell types (SMM) into infarcted rats. METHODS Myocardial infarction was induced by ligature of the left coronary artery in 26 Wistar rats. After one week, the animals underwent echocardiography for assessing ejection fraction (EF%) and left ventricular end-diastolic and systolic volumes (EDV, ESV, mL). After 2 days, the animals were reoperated on and divided into 2 groups: 1) control (n = 10), which received 0.15 mL of culture medium; and 2) SMM (n = 16), which received 7.5x10(6) heterologous skeletal myoblasts and mesenchymal cells in the infarcted region. The cells were obtained from puncture of the iliac crest and biopsy of skeletal muscle, and were cultured in vitro. After one month, the animals underwent a new echocardiography. RESULTS No significant difference in EF, EDV, and ESV was observed between the 2 groups on baseline echocardiographic values. One month after transplantation, the following was observed: a reduction in EF in the control group (29.31 +/- 5.6% to 23.54 +/- 6.51%; P = 0.048); and an increase in EF in the SMM group (24.03 +/- 8.68% to 31.77 +/- 9.06%; P = 0.011). The presence of neovascularization and muscle fibers was identified in the regions of myocardial fibrosis in the SMM group. CONCLUSION Cocultivation of skeletal myoblasts and mesenchymal cells is functionally effective.
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Andresen H, Kaag N, Meinhardt A, Potratz J. Strahlenschaden des Herzens. Zeitschrift f�r Kardiologie 2003; 92:957-61. [PMID: 14634766 DOI: 10.1007/s00392-003-0979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Accepted: 06/10/2003] [Indexed: 11/28/2022]
Abstract
Radiation-induced effects may damage various cardiac structures chronically and cause heart valve dysfunction as well as occlusive lesions of coronary and other arteries exposed to radiation. A 72-year-old woman with a history of radiation treatment after breast cancer was admitted 25 years later with symptoms of tachycardia and acute dyspnea. We found valvular thickening, medium to severe valvular dysfunction and high grade occlusive coronary artery disease in proximal portions. The left subclavian artery also was affected. Surgical treatment was required immediately. Long-term follow-up cardiac evaluation even in asymptomatic patients is mandatory to uncover cardiac injuries by radiation. To lower the risk and maximize the benefit, early intervention by valvular replacement and myocardial revascularization is indicated. Restrictive myopathy and chronic pericarditis increase risk and have to be clarified. Diagnosis in these radiation exposed patients can be made by typical findings. Echocardiography is of eminent relevancy.
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Affiliation(s)
- H Andresen
- I. Medizinische Klinik, Diakoniekrankenhaus Rotenburg, 27342 Rotenburg, Germany.
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Fernández Vázquez E, Lacárcel Bautista C, Alcázar Navarrete B, Casado Moreno I, Espejo Guerrero A, Ruiz Carazo E. [Chronic thromboembolic pulmonary hypertension associated with endomyocardial fibrosis of the right ventricle]. Arch Bronconeumol 2003; 39:370-2. [PMID: 12890406 DOI: 10.1016/s0300-2896(03)75406-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic thromboembolic pulmonary hypertension is a rare sequela to an acute untreated or recurrent pulmonary embolism. The mechanisms that underlie the failure to resolve the thrombus are still uncertain. As most patients are not diagnosed until a relatively late stage, little is known about the course of their illness. We report the case of a 51-year-old woman who had previously been diagnosed with and operated on for endomyocardial fibrosis of the right ventricle and who developed chronic thromboembolic pulmonary hypertension several years later.
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Affiliation(s)
- E Fernández Vázquez
- Servicio de Neumología. Hospital Universitario Virgen de las Nieves. Granada. España.
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León-Ruíz L, Jiménez-Alonso J, Hidalgo-Tenorio C, Díaz-Ricomá N, Pérez-Alvarez AF, León-Villaverde B, Lara-Torrano J, Concha-López A. Churg-Strauss syndrome complicated by endomyocardial fibrosis and intraventricular thrombus. Importance of the echocardiography for the diagnosis of asymptomatic phases of potentially severe cardiac complications. Lupus 2003; 11:765-7. [PMID: 12475009 DOI: 10.1191/0961203302lu245xx] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jatene MB, Contreras ISB, Lameda LCR, Oliveira JDL, Ebaid M, Iwahashi ER, Abellan DM, Aiello VD, Marcial MB, de Oliveira SA. Endomyocardial fibrosis in infancy. Arq Bras Cardiol 2003; 80:438-45. [PMID: 12754563 DOI: 10.1590/s0066-782x2003000400007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The patient was a 4-month-old infant, who underwent persistent ductus arteriosus interruption with titanium clips at the age of 13 days and, since the age of 2 months, had crises of hypoxia and hypertonicity. After clinical investigation, the presence of pulmonary hypertension was confirmed and left ventricular inflow tract obstruction was suspected. The patient underwent surgical treatment at the age of 4 months, during which right and left ventricular endocardial fibrosis was identified. The fibrosis was resected, but the infant had an unfavorable clinical evolution with significant diastolic restriction and died on the sixth postoperative day. Anatomicopathological and surgical findings suggested endomyocardial fibrosis, although that pathology is very rare at the patient's age.
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Affiliation(s)
- Marcelo Biscegli Jatene
- Divisão Cirúrgica, Setor de Cirurgia Cardíaca Pediátrica, Instituto do Coração, Hospital das Clínicas, FMUSP, Sao Paulo, SP, Brazil.
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Affiliation(s)
- Raja Joshi
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Abstract
A 25-year-old man in New York Heart Association functional class IV with right ventricular endomyocardial fibrosis received a palliative bidirectional Glenn shunt. Despite a stormy postoperative convalescence the bidirectional Glenn shunt provided good long-term palliation.
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Affiliation(s)
- Amit Mishra
- Department of Cardiovascular Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences Technology, Thiruvananthapuram, Kerala, India
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Niino T, Shiono M, Yamamoto T, Inoue T, Hirose H, Saito A, Funahasi M, Negishi N, Sezai Y, Honma T, Nemoto N. A case of left ventricular endomyocardial fibrosis. Ann Thorac Cardiovasc Surg 2002; 8:173-6. [PMID: 12479177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
The patient was a 29-year-old woman. When she consulted a local physician with chief complaints of fever and fatigue of the extremities, cerebral infarction was detected on MRI, in addition to abnormalities found on ECG. Ultrasonic cardiography revealed the presence of a tumor in the left ventricle. Therefore, tumorectomy and endocardectomy were performed under extracorporeal circulation based on a diagnosis of cardiac tumor. Inflammatory cell infiltration into the ventricular wall was pathologically confirmed, and eosinophilia was observed preoperatively. Therefore, the patient was diagnosed as having endomyocardial fibrosis, which is rarely observed in Japan. The postoperative course of this patient was satisfactory, and the eosinophil count was normalized postoperatively. At present, this patient is being followed at the outpatient clinic.
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Affiliation(s)
- Tetsuya Niino
- Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
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Abstract
A case is presented of the Churg-Strauss syndrome with hypereosinophilia and severe cardiac involvement, namely biventricular endomyocardial fibrosis and gross encroachment of the right ventricular cavity. The clinical picture was similar to Loeffler's syndrome and the idiopathic hypereosinophilic syndrome. Combined aggressive surgical and medical management led to full recovery and survival at 10 years. The good long term outcome is attributed to strict control of peripheral eosinophil count by oral corticosteroids. This case illustrates the damaging effects of hypereosinophilia on the heart.
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Affiliation(s)
- C R McGavin
- Department of Respiratory Medicine, Derriford Hospital, Plymouth PL6 8DH, UK.
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Saraiva LR, Parente GB, Lira V. [Aschoff nodules and myocardial fibrosis papillary muscles of the left ventricle]. Arq Bras Cardiol 2001; 77:285. [PMID: 11562693 DOI: 10.1590/s0066-782x2001000900011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- L R Saraiva
- Disciplina de Cardiologia, Universidade Federal de Pernambuco, Pernambuco, PE.
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Abstract
We describe 10 children with endomyocardial fibrosis who underwent surgical treatment between 1978 and 1999. Seven were male and 3 female, with an age range from 4 to 15 years, having a mean age of 11 years. All were in the final stage of heart failure. Three had biventricular disease, 6 had involvement of the right ventricle alone, and one had endomyocardial fibrosis confined to the left ventricle. There were 3 deaths (30%) in the postoperative period due to low cardiac output. The 7 survivors were followed up for a period ranging from 12 to 168 months, with a mean of 72 months. Two late deaths have occurred resulting from heart failure and infectious endocarditis. Five (50%) children are still alive. Two required 3 reoperations for dysfunction of the inserted valvar prosthesis. One patient is in functional Class IV, and 4 are in Class II to III, despite intensive medical treatment. It is concluded that surgery for endomyocardial fibrosis is an essentially palliative procedure and, especially in children, the results of surgical treatment leave much to be desired.
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Affiliation(s)
- C L Santos
- Heart Institute of Pernambuco, Real Hospital Portugues, Recife, Brazil
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26
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Abstract
Following aortic reimplantation of anomalous left coronary artery from the pulmonary artery in a 6-month-old infant, the heart failed to wean after prolonged supportive cardiopulmonary bypass and maximal inotropic support. We performed partial left ventriculectomy (Batista procedure) that halved left atrial pressure and enabled discontinuation of bypass. Postoperative recovery was then uneventful.
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Affiliation(s)
- S Westaby
- Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, United Kingdom.
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Affiliation(s)
- F Hornero
- Servicio de Cirugía Cardíaca, Hospital General Universitario de Valencia, Valencia, Spain.
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Grande-Allen KJ, Ratliff NB, Griffin BP, Cosgrove DM, Vesely I. Case report: outer sheath rupture may precede complete chordal rupture in fibrotic mitral valve disease. J Heart Valve Dis 2001; 10:90-3. [PMID: 11206774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Rupture mechanics of mitral valve chordae have been difficult to elucidate because most surgical repairs and pathological examinations are performed after the rupture. In an excised anterior leaflet from a fibrotic mitral valve, chordae were observed in an initial phase of rupture. Microscopic sections showed that thinned, nearly ruptured chordal segments were actually chordal cores, containing highly aligned collagen fibers. The outer sheath of elastic fibers, disorganized circumferentially oriented collagen fibers, and endothelial cells that normally surrounds the collagen core apparently had retracted to the extreme ends of the thinned segment, resulting in a bulbous shape, as noted in the chordal rupture literature. In conclusion, these new observations lead us to propose that the rupture of mitral valve chordae is not spontaneous, but may occur over time. The failure of the outer sheath may represent the first phase in a slow, two-part process leading to eventual chordal rupture.
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Affiliation(s)
- K J Grande-Allen
- Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Ohio 44195, USA
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29
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Berensztein CS, Piñeiro D, Marcotegui M, Brunoldi R, Blanco MV, Lerman J. Usefulness of echocardiography and doppler echocardiography in endomyocardial fibrosis. J Am Soc Echocardiogr 2000; 13:385-92. [PMID: 10804436 DOI: 10.1016/s0894-7317(00)70008-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our goal was to demonstrate the usefulness of echocardiography and cardiac Doppler echocardiography (echo-Doppler) in the diagnosis of endomyocardial fibrosis, an unusual restrictive cardiomyopathy in Argentina. METHODS Between 1980 and 1998, we studied 10 women (aged 27 to 58 years) with endomyocardial fibrosis confirmed by surgery and/or endomyocardial biopsy. Of the 10 cases of endomyocardial fibrothrombosis, 8 were biventricular and 2 were left ventricular. Six patients had only an echocardiographic study, and the last 4 patients (after 1987) had an echo-Doppler study also; 3 had a transesophageal echocardiography examination as well. Seven patients had grade III-IV dyspnea, 2 had an edematous-ascitic syndrome, and 1 had right heart failure at the first examination. Four patients died of heart failure and 1 of overimposed sepsis. Surgery was successful in 2 patients with the biventricular form of the disease. In one of them, fibrotic decortication was performed in both ventricles together with tricuspid and mitral replacement. In the other, the right side was not surgically treated because of its mild engagement. One patient was lost to follow-up, and 3 patients are awaiting surgery at this writing. RESULTS In all 10 patients, echocardiography was the first diagnostic tool used. In M-mode echocardiography, the typical image showed the "square root" sign in the septum and posterior wall in addition to the "merlon" sign, characterized by a hypercontractile basal ventricle opposing an obliterated apex. In 2-dimensional echocardiography, inversion of the normal sized heart with obliterated ventricles and dilated atria were seen in the whole group. In 1 patient, the fibrous thrombus was limited to the apex of the right ventricle (Shaper's type 1) in a biventricular form, whereas in the left side of this patient and in the other 9 patients, the fibrous thrombus that initially occupied the apex engaged the posterior papillary muscle, pulling the posterior valve downward (Shaper's type 2) and generating tricuspid and/or mitral regurgitation that was always mild or moderate. The fibrous thrombus never altered the movement of the underlying myocardium. There were hypoechoic and hyperdense echoes inside the fibrotic material (the latter compatible with calcium), and in all 10 patients, different grades of pericardial effusion were found. Echo-Doppler showed the same minimal percentage of change in mitral and tricuspid velocities as found in healthy patients, which clearly differentiates endomyocardial fibrosis from constrictive pericarditis. Furthermore, a restrictive pattern was observed on both atrioventricular valves when both sides were engaged with a markedly short tricuspid deceleration time. Pulmonary veins showed a markedly diastolic D wave and a broad reversal A wave (the latter presented a low velocity when the wall of the left atrium was diseased) caused by an increased end-diastolic left ventricular pressure to the same extent throughout the respiratory cycle. Hepatic veins showed a markedly deep diastolic forward wave throughout the respiratory cycle and a marked reversal with inspiration. CONCLUSIONS We showed (1) echocardiographic studies of a significant number of patients with this unusual disease, (2) the characteristic diagnostic signs in M-mode and 2-dimensional echocardiography, and (3) the common echo-Doppler patterns shared by all subjects studied with this technique.
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Affiliation(s)
- C S Berensztein
- Hospital de Clínicas "José de San Martin," Buenos Aires, Argentina.
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30
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Yin R. Endomyocardial fibrosis in China. Chin Med Sci J 2000; 15:55-60. [PMID: 12899403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE To introduce the epidemical, pathological, and clinical characteristics as well as the diagnostic and therapeutical experiences of endomyocardial fibrosis (EMF) in China. DATA SOURCES A CMBdisc search was done of the Chinese-language literature published from January 1983 through June 1997 about EMF and/or restrictive cardiomyopathy. A manual search was then done for other contributions, including abstracts, between January 1965 and June 1997. RESULTS Eighty-seven Chinese cases of EMF were collected in this paper. There were 49 men and 38 women, with a mean age of 28 +/- 13 years (range, 8 to 68 years). The distribution of the cases is mainly in the south of China. Combined right and left ventricular disease occurs in 48 percent of cases, with pure right ventricular involvement occurring in 12 percent and pure left ventricular involvement in the remaining 10 percent of patients who are examined postmortem. The diagnosis of EMF was confirmed in 21 cases at autopsy, and in 66 cases by echocardiography, angiocardiography, and/or endomyocardial biopsy which showed the characteristic changes. Clinically, right-sided disease is the commonest variety. Endocardiectomy and tricuspid (n - 7) or mitral (n - 1) valves replacement have been performed in 8 patients. There were 2 operative deaths. Six patients had a satisfactory recovery postoperatively and living well in the follow-up duration. CONCLUSION EMF has been diagnosed clinically and confirmed at necropsy in a number of cases in the south of China. The etiology, incidence and epidemiology are still unknown. The pathological and clinical features are similar to those in tropical areas, but right ventricular involvement is the commonest type in our country.
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Affiliation(s)
- R Yin
- Institute of Cardiovascular Diseases, Guangxi Medical University, Nanning 530021
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31
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Zabsonre P, Adoh Adoh M, Abouo N'Dori R, Quezzin-Coulibaly A. [Early post-operative arrhythmias in endomyocardial fibrosis or chronic parietal endocarditis in 84 cases studied at the Cardiology Institute of Abidjan]. Dakar Med 2000; 45:147-50. [PMID: 15779172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors have studied rhythmic events happened during early post-operative period in 84 operated patients for endomyocardial fibrosis, synonym nowadays to chronic parietal endocarditis, in the Institute of Cardiology of Abidjan (Côte d'lvoire), from January 1977 to July 1991. The mean age has been 15.6 +/- 43 years old. Endocardectomy was left in 25 cases, right in 32 and at last bilateral in the 19 others. The surgical way has been a left and/or right atriotomy. Mitral and/ ortricuspide valvular surgery has been always realised. The absolute prevalence of patients having presented one or several arrhythmias, atrial tachycardia and premature ventricular beats. The favouring factors have been the period of exclusion of the aortic root from circulation and number of endomyocardectomy. Atrial fibrillation has been related to auricular volume. Most of nodal arrhythmias have appeared with surgery. Endomyocardial fibrosis surgery has been greatful in rhythmic plan in 16% of patients. Early post-operative arrhythmias have been responsible forone case of the death of the operated patients and they have been present in seven other cases of the death.
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Affiliation(s)
- P Zabsonre
- Service des Soins Intensifs, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
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32
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Zabsonre P, Renambot J, Adoh-Adoh M, N'Dori R, Coulibaly AO, Bertrand E. [Conduction disorders in chronic parietal endocarditis or endomyocardial fibrosis. 170 cases at the Cardiology Institute of Abidjan]. Dakar Med 2000; 45:15-9. [PMID: 14666783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The authors have conducted research on conduction disturbances in the endomyocardial fibrosis, synonymous with chronic parietal endocarditis, about 170 cases at the Institute of Cardiology in Abidjan, from January 1977 to June 1991. The anatomical and/or angiographic examination have permitted to describe 64 cases of right fibrosis, 24 cases of left fibrosis and 82 cases of bilateral fibrosis. Conduction anomalies have been observed among 42.9% of the patients. Among 92 anomalies recorded, the most frequent has been the first degree heart block (43.5%) and the incomplete right bundle branch block (30.4%). The old age of the patients and the right localization were the factors associated with conduction disturbances in endomyocardial fibrosis (difference not significant). Yet, fibrosis surgery, especially the decortication of the fibrous endocardium of the right ventricle, have generated one or many conduction anomalies among most of our operated patients. The right branch of the fasciculus of the His has been the most injured by the fragmented techniques of METRAS who had, therefore, the merit to have minimized the incidence of the complete post-operative heart blocks still high in European and Brazilian series. In term of prognosis, no conduction disturbance has directly caused a patient's death, even if those anomalies cannot be totally ruled out in the 16 cases of sudden death.
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Affiliation(s)
- P Zabsonre
- Institut de Cardiologie d'Abidjan, Côte d'Ivoire
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33
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Abstract
OBJECTIVE To identify life expectancy after surgery for endomyocardial fibrosis (EMF) and the events that influence it. METHODS Eighty-three patients with EMF underwent endocardial decortication and atrioventricular valve replacement or repair, between December 1977 and December 1997. There were 66 (79.6%) female and 17 (20.4%) male patients, ranging in age from 4 to 59 years (mean, 31). Thirty-seven (44.5%) had biventricular disease, 34 (41.0%) had disease of the right ventricle alone and 12 (14.5%) had EMF confined to the left ventricle. All were in functional class III or IV (New York Heart Association classification). RESULTS Sixty-eight (81.9%) patients survived the operation and were followed up for periods ranging from 2 months to 17 years. The total follow-up time was 6290 patient/months (mean, 92 months). There were 15 late deaths, but in six, the cause was not related to the underlying disease. Four (5.8%) patients presented recurrence of the fibrosis and were reoperated on and in six (8.8%), EMF appeared in the other ventricle. Five (7.3%) patients were reoperated on to replace either a valve prosthesis or a native valve which had been preserved during the first procedure. Only 24 (45%) of the 53 surviving patients are in functional class I or II. The actuarial probability of survival at 17 years, including operative mortality, was 55%. CONCLUSION Surgical treatment of EMF should be considered a palliative procedure because surgery does not alter the progressive nature of the disease. However, surgical therapy is recommended for patients with EMF and heart failure as it is their only hope of survival.
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Affiliation(s)
- F Moraes
- Department of Surgery, Federal University of Pernambuco, Heart Institute of Pernambuco, Recife, Brazil
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34
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Abstract
We studied the incidence of AF in patients with endomyocardial fibrosis (EMF) and its influence on prognosis and associated clinical events. One hundred and sixty consecutive patients with EMF were followed for a mean period of 4 years. Their mean age was 39.7 years. There were 114 women. During follow-up there were 56 deaths. Eighty-eight patients (55%) were submitted to surgical intervention. AF was observed in 58 cases (36.2%). The presence of AF was associated with a greater prevalence of dyspnea, peripheral edema, hepatomegaly, lower left ventricular ejection fraction, lower right ventricular systolic pressure (37.8 vs 45.6 mmHg, P=0.0392), and greater incidence of tricuspid regurgitation (86.0 vs 63.2%, P=0.004). AF was more frequent among patients in whom the disease involved the right ventricle, particularly those with intense fibrosis. Overall, patients with AF had a higher mortality rate than those who did not have AF (43.1 vs 30.3%, P=0.0195), but among those submitted to surgery, AF did not have an impact on survival. In conclusion, AF is frequent among patients with EMF. It is more prevalent among patients with right ventricular involvement and its presence is associated with a greater incidence of heart failure. AF is associated with worse prognosis, but surgery potentially reverses this bad evolution.
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Affiliation(s)
- A C Barretto
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Cardiologia Social, Brazil
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35
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Abstract
AIMS To determine the long-term outcome of patients with endomyocardial fibrosis and to compare echocardiographic and haemodynamic data before and after ventricular endocardial resection. PATIENTS Seventeen patients (11 women and six men; mean age 35.5 years) diagnosed with endomyocardial fibrosis at the University Hospital in Zurich, Switzerland from 1971 to 1995. Twelve patients (70%) had partial obliteration of both ventricles and in five patients (30%) the fibrotic lesions were limited to the left ventricle. METHODS Fourteen of the 17 patients had surgical resection: fibrosis was resected from both ventricles in five patients and from the left ventricle only in nine patients. Ten patients had mitral valve replacement and two had tricuspid valve replacement. Left ventricle endocardial resection was done without reconstruction or replacement of the atrioventricular valve in three patients. Preoperative and postoperative echocardiographic data were available for 11 patients and haemodynamic data for six patients. Patients were followed up for 0.4-19 years (mean 8.6). RESULTS Preoperatively four patients were NYHA functional class IV and 10 were class III; postoperatively one patient was class III, seven class II, and six class I. Preoperatively, echocardiography showed obliteration of the left ventricular apex and inflow tract in all patients, which decreased or disappeared after surgery. Left ventricular end diastolic pressure decreased from 25 mm Hg before surgery to 14 mm Hg after successful resection of the fibrosis. Left ventricular and diastolic volume (normal 93 (17) ml/m2) increased from 65 ml/m2 to 97 ml/m2 (p < 0.05) after surgery. Ejection fraction was normal preoperatively (57%) and decreased slightly (52%) after surgery. One patient died five months after surgery from heart failure. Four surgically treated patients died during the follow up period: one each from systolic dysfunction, recurrence of endomyocardial fibrosis, pneumonia, and food poisoning. Overall survival was 65% at five years and 59% at 10 years; the survival rates of the operated patients was 72% and 68%, respectively. Only one of the medically treated patients survived longer than three years from diagnosis. CONCLUSIONS Endomyocardial fibrosis is a rare disease in European countries and is found mainly in women. The clinical picture is characterised by severe congestive heart failure but heart size is only moderately increased. Systolic performance is normal or only slightly depressed despite severe restriction to filling, atrioventricular valve regurgitation or both. Partial obliteration of the right and/or left ventricle may be detected by echocardiography. Endocardial resection with atrioventricular valve replacement is the treatment of choice with appreciable postoperative improvement and 10 year survival of approximately 70%.
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Affiliation(s)
- U Schneider
- Division of Cardiology, University Hospital, Zurich, Switzerland
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36
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37
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Abstract
The idiopathic hypereosinophilic syndrome is a leukoproliferative disorder marked by a predilection to damage specific organs, including the heart. This report describes a patient with extensive endocardial fibrosis accompanying this syndrome. Right ventricular endomyocardectomy with preservation of the tricuspid valve was performed. The procedure was aided by cine-magnetic resonance imaging for preoperative assessment and follow-up of surgical results.
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Affiliation(s)
- M Chandra
- Department of Medicine, Emory University, Atlanta, Georgia, USA
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38
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de Oliveira SA, Dallan LA, Barretto AC, Mady C, Jatene AD. [Endomyocardial fibrosis surgery with atrioventricular valve preservation]. Arq Bras Cardiol 1996; 67:289-95. [PMID: 9181731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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39
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Moraes CR, Buffolo E, Moraes Neto F, Rodrigues JV, Gomes CA, Branco JN, Aguiar L. [Recurrence of fibrosis after endomyocardial fibrosis surgery]. Arq Bras Cardiol 1996; 67:297-9. [PMID: 9181732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- C R Moraes
- Universidade Federal de Pernambuco, Escola Paulista de Medicina, São Paulo
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40
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Abstract
Isolated noncompaction of the ventricular myocardium is a recently described anomaly. We report the first case of this anomaly presenting as a restrictive cardiomyopathy, and the first association of this entity with endocardial fibrosis.
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Affiliation(s)
- S Hook
- Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195-5001, USA
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41
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Metras D. Valvular heart disease: the influence of changing etiology on nosology. J Heart Valve Dis 1994; 3:692-3. [PMID: 8000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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42
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Valiathan MS. Endomyocardial fibrosis. Natl Med J India 1993; 6:212-6. [PMID: 7694719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M S Valiathan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, Kerala, India
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43
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Mady C. [Endomyocardial fibrosis]. Arq Bras Cardiol 1992; 59:483-6. [PMID: 1341874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- C Mady
- Instituto o Coração, Hospital das Clínicas, FMUSP
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44
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Uva MS, Jebara VA, Acar C, Dervanian P, Chauvaud S, Fuzellier JF, Fabiani JN, Deloche A, Carpentier AF. Mitral valve repair in patients with endomyocardial fibrosis. Ann Thorac Surg 1992; 54:89-92. [PMID: 1610260 DOI: 10.1016/0003-4975(92)91146-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Between 1987 and 1990, 12 patients were operated on for endomyocardial fibrosis at our institution. Nine were treated by endocardectomy and mitral valve repair and constitute the material of this study. Ages ranged from 9 to 58 years (mean age, 32.5 years). Biventricular involvement was present in 3 cases, and 6 patients had predominantly left ventricular endomyocardial fibrosis. Six patients were in New York Heart Association class III/IV. Six patients had severe mitral insufficiency (3 to 4/4) and 3 patients had moderate mitral insufficiency (2/4). The operation consisted of left ventricular endocardectomy with complete detachment and mobilization of the posterior leaflet of the mitral valve in all cases. An autologous pericardial patch was used to reconstruct posterior leaflet continuity in 4 patients. In 7 patients a prosthetic mitral ring was used. In 3 patients right ventricular endocardectomy and tricuspid valve repair were also performed. All patients survived and none required early reoperation. Follow-up was complete and ranged from 9 to 38 months. No late deaths occurred, and 1 patient required mitral valve replacement for recurrent mitral regurgitation. Doppler echocardiographic studies were performed in 7 patients and revealed no or mild mitral insufficiency. In conclusion, mitral valve repair is safe and offers good early and late results in patients with endomyocardial fibrosis.
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Affiliation(s)
- M S Uva
- Department of Cardiovascular Surgery, Hôpital Broussais, Paris, France
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45
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Abstract
Radiation-associated coronary atherosclerosis is a potential problem for patients who have had mediastinal irradiation for malignant tumors. This study identified 14 patients with radiation-associated coronary atherosclerosis, defines unique population characteristics, and analyses postsurgical problems and long-term outcome. Fourteen patients with radiation-associated coronary atherosclerosis and class III and IV New York Heart Association symptoms were identified because of mediastinal or chest wall irradiation (30 Gy) associated with anterior epicardial discoloration or fibrosis, aortitis with adventitial thickening, and inflammatory process over a proximal coronary artery. Two distinct treatment groups were analyzed. Coronary artery operation resulted in one hospital death, with vein grafts being used predominantly. The internal mammary artery could only be used in 3 patients because of vessel friability and mediastinal fibrosis. Postoperative right ventricular dysfunction and pulmonary problems were frequent. Severe pericardial inflammatory complications (fibrosis with graft closure, and constrictive pericarditis) present in 2 early patients resulted in routine anterior pericardiectomy after coronary artery operation without further problems. Long-term follow-up (100%) (range, 11 to 74 months) revealed that 1 patient died late and of the remainder (12 patients), 11 were in New York Heart Association class I and 1 in class II, experiencing three myocardial events. Thus, patients with radiation-associated coronary atherosclerosis have a low operative mortality but have risk of early right ventricular and pulmonary dysfunction. The routine use of internal mammary artery may not be possible and anterior pericardiectomy is recommended. Long-term results are excellent and no evidence of accelerated disease has been noted.
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Affiliation(s)
- G L Hicks
- University of Rochester Medical Center, New York
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46
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Abstract
Endomyocardial fibrosis is an endemic problem in tropical countries and is characterised by ventricular cavity obliteration, decreased ventricular compliance, and atrioventricular valve regurgitation. We report on a patient with right ventricular endomyocardial fibrosis resulting in obliteration of the cavity and tricuspid regurgitation treated successfully by total cavopulmonary connection and exclusion of the right ventricle.
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Affiliation(s)
- N Kumar
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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47
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Dervanian P, Acar C, Jebara VA, Deloche A, Fabiani JN, Carpentier A. [Mitral valvuloplasty for endomyocardial fibrosis in a child with acute leukemia and hypereosinophilia]. Arch Mal Coeur Vaiss 1991; 84:1861-4. [PMID: 1793325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors report the case of a child with acute lymphoblastic leukaemia and hypereosinophilia complicated by left sided endomyocardial fibrosis. Despite the need for urgent treatment and severe mitral valve disease, a complex mitral valvuloplasty was performed, consisting of mobilisation and reconstruction of the posterior leaflet, burying the chordae with plicature of the papillary muscle of the anterior leaflet associated with an annuloplasty. Decortication was performed by a transvalvular approach. The technique of mobilisation-reconstruction of the posterior mitral leaflet with a pericardial patch should widen the indication of conservative surgery in this condition, in the presence of dominant mitral regurgitation in the child.
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Affiliation(s)
- P Dervanian
- Département de chirurgie cardiovasculaire, hôpital Broussais, Paris
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48
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Just A, Hammel D, Peters PE. [An unusual cardiac configuration. Heterotopic heart transplantation in endomyocardial fibrosis]. Radiologe 1991; 31:263-4. [PMID: 1876702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A Just
- Institut für Klinische Radiologie-Röntgendiagnostik, Westfälische Wilhelms-Universität Münster
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49
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Babliak DE, Faĭnik OF, Ivaniv IA, Kulyk LV, Averchuk VG. [Endomyocardial fibrosis with massive calcinosis of the endocardium of the left ventricle]. Grud Serdechnososudistaia Khir 1991:57-8. [PMID: 2059507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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50
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Abstract
Endomyocardial fibrosis has been treated surgically for many years. For complete removal of fibrosis from both ventricles by the classic technique, each atrioventricular (AV) valve was removed and replaced with a prosthesis. Relapse of endomyocardial fibrosis has not been observed after surgical correction. Reoperations have been carried out because of complications of valve prostheses. A new surgical technique for removal of ventricular fibrous tissue with preservation of the mitral and tricuspid valves was used in nine consecutive patients with endomyocardial fibrosis. Initial results show a reduction of pulmonary hypertension, mean right and left atrial pressures and end-diastolic pressures in both ventricles. Tricuspid annuloplasty was performed in seven patients and mitral annuloplasty in five. No valve prosthesis was used. There was no death and New York Heart Association functional class improved from class III or IV in the preoperative period to class I or II in the postoperative period. These data suggest that resection of endocardial fibrous tissue can be indicated early in the clinical course and performed with preservation of the AV valves.
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Affiliation(s)
- S A de Oliveira
- Instituto do Coração, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Brazil
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