Early surgical results in the treatment of endomyocardial fibrosis A brazilian cooperative study

Abstract

This report summarizes the surgical experience and early results obtained at four surgical centers in the northeast and south of Brazil. From December 1977 to September 1986, 95 operations were performed on 93 patients, ages 11-59. Bilateral lesions occurred in 42 patients, right lesions in 39, and left lesions in 12. Ventricular decortication and removal of thrombi were performed in all. In right-sided lesions, the tricuspid valve was substituted by a bioprosthesis in 34 cases, and substituted by a tilting disk valve in 1 case. In 4 patients, the valve could be preserved. The left-sided lesions led to valve substition by a bioprosthesis in 11 cases, and preservation of the valve in 1. The bilateral lesions needed bioprosthesis in the mitral position in 37 patients, and a disk valve in 2. In these 39 instances, the valvular procedure was insertion of a tricuspid bioprosthesis. Three tricuspid and three mitral plasties were performed. The overall mortality was 20% (26.2% for bilateral lesions, 14.6% for the right-sided lesions, and 20% for the left-sided lesions). The main cause of death was low cardiac output. Aside from a variable degree of right and left ventricular failure, many other non-fatal complications clouded the postoperative course. Complete AV blocks occurred in 10 cases, with the need for permanent pacing in 7 survivors. The mortality and morbidity in the present series is in keeping with the results reported in current literature. Regarding the advanced stage of their patients' disease, the authors agree with the recommendation for earlier surgical intervention.

Endomyocardial fibrosis in children

“…Early and late results of surgical treatment are well described. [16][17][18][19][20][21] The high operative mortality, of up to one-fifth, observed in most of the reported series indicates the severity of the cardiac cachexia of most patients at the time of operation. It seems to be worse in children who, as shown by our experience, have always presented in the final stage of heart failure and in poor preoperative general condition.…”

Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d’Ivoire

“…EMF extended most frequently to all the endocardium, sticking the chordaes, the papillary muscles and the valvular tissues; what justifies the predominance of valvular replacement rather than valve repair in our study. Hospital mortality was high in the literature: 20% for Moraes (60)(61)(62), 16% for Metras (63); in our study on bilateral EMF in children we reported an early mortality after surgery at 29.4% (64). Fibrosis is not recurring as evocated by Tharakan (59); it indicates the end of a pathological process and the proof was given during an autopsy carried out in Abidjan with a patient 4 years after a right EMF surgery (65).…”

Tropical endomyocardial fibrosis: an overview

“…73 Since most patients have extensive disease at the time of presentation; therefore, survival after diagnosis is relatively brief, averaging approximately two years after symptom onset. 74 In one study, 95% of a group of patients had died at two years. 75 In a second study, 44% of patients died within one year after the onset of symptoms, and another 40% of patients died 1-3 years after onset of symptoms.…”