Chronic Pericardial Effusion Complicating Endomyocardial Fibrosis

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Abstract
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.