ENDOMYOCARDIAL FIBROSIS - EARLY AND LATE RESULTS OF SURGERY IN 20 PATIENTS

  • 1 January 1982
    • journal article
    • research article
    • Vol. 83  (1) , 52-64
Abstract
Patients (20) with endomyocardial fibrosis (EMF), the largest series reported to date, were operated upon between June 1978 and June 1980. Eleven were male and 9 female, ranging in age from 6-23 yr (mean 13.3 yr). There were 7 cases of right ventricular (RVEMF), 6 of left ventricular (LVEMF) and 7 cases of bilateral EMF. All patients underwent endocardiectomy and atrioventricular valve replacement with a xenograft. Four patients had an additional valvular annuloplasty. There were 4 postoperative deaths (all bilateral EMF): 2 from low cardiac output and 1 each from hepatic failure and cerebral malaria. There was 1 late death from serum hepatitis. The other patients had a relatively difficult postoperative course, but none of the 20 patients had atrioventricular block. The longest follow-up of the 15 survivors is 28 mo. (mean 16.7 mo.). All patients are symptom free. Three take digitalis and/or diuretics. Ten were recatheterized from 6 mo. to 1 yr after operation. Intracardiac pressures, the ventricular cineangiogram, liver and heart size returned to normal in patients with LVEMF; in RVEMF, despite clinical improvement, most of these parameters remained abnormal. Of special interest were the recognitions of an early type of LVEMF and the surgical preservation of a thin juxta-annular rim of fibrosis in the right ventricle to avoid atrioventricular block. Operation is indicated in all patients with LVEMF, despite greater risk. Early intervention is advised in RVEMF to avoid irreversible liver damage and cardiac enlargement.

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