Related Experiment Videos
Endomyocardial fibrosis masquerading as rheumatic mitral incompetence. A report of six surgical cases
Abstract:
This report presents six cases (among 43 surgical cases) of left ventricular EMF presenting as pure mitral insufficiency without any echocardiographic or hemodynamic signs of left ventricular EMF (except apical diverticulum in two cases). Five of these cases were diagnosed at operation, and the sixth was diagnosed on the basis of a characteristic right ventricular angiogram. At operation a fibrotic lesion localized to the level of the anteropapillary muscle, with severe mitral insufficiency, was found. Five patients underwent successful mitral valve replacement and one a successful conservative mitral valve procedure. Postoperative angiograms, done in two patients, showed a normal contour of the left ventricle. A review of the literature did not reveal any previous descriptions of this type of limited left ventricular EMF, mimicking rheumatic mitral insufficiency. In our surgical experience, we have encountered three types of left ventricular EMF: obliterative, extensive, and limited. We emphasize EMF as a possible cause of mitral insufficiency in African children.
Insights
This study identifies a limited form of left ventricular endomyocardial fibrosis (EMF) causing mitral insufficiency in African children. This specific EMF type mimics rheumatic heart disease and requires surgical intervention for successful treatment.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Endomyocardial fibrosis (EMF) is a restrictive heart disease.
- Left ventricular EMF can lead to mitral insufficiency.
- Limited forms of EMF may present atypically.
Purpose of the Study:
- To describe six cases of a limited left ventricular EMF.
- To highlight EMF as a potential cause of mitral insufficiency in African children.
- To differentiate this limited EMF from other forms and rheumatic mitral insufficiency.
Main Methods:
- Retrospective review of surgical cases.
- Clinical presentation, echocardiography, and hemodynamic data analysis.
- Intraoperative findings and postoperative angiographic assessment.
Main Results:
- Six cases of limited left ventricular EMF presenting as pure mitral insufficiency were identified.
- Diagnosis was often made intraoperatively or via right ventricular angiogram.
- Successful mitral valve surgery was performed in all patients.
- Postoperative angiograms showed normalized left ventricular contours.
Conclusions:
- A limited form of left ventricular EMF, previously undescribed, can mimic rheumatic mitral insufficiency.
- EMF should be considered in African children with mitral insufficiency, even without typical echocardiographic signs.
- Surgical management of mitral valve disease secondary to limited EMF is effective.