Abstract 2333: Good Intermediate-Term Results of a Novel Tailored Approach to the Treatment of Endomyocardial Fibrosis
Introduction - Endomyocardial Fibrosis (EMF) is the most common cause of restrictive cardiomyopathy, which carries a very poor prognosis in symptomatic patients. The aetiology of the disease remains unknown and to date there is no specific therapy. Surgical treatment depends on accurate characterization of the structural and functional changes in each patient.
Methods - We developed a surgical program of new reparative procedures targeting the specific components of the disease which included:
fibrous plaques interfering with systolic and diastolic regional ventricular function;
diminution of ventricular volume by obliteration of the trabecular part of the right ventricle;
immobilization of the papillary muscles of the mitral valve which can be totally embedded in the ventricular wall;
occasional fusion of the mitral cusps;
dilatation of the tricuspid or mitral valve annulus and
massive dilatation of right and left atria.
Results - Between December 2004 and May 2008 we have used this technique in 29 patients with advanced EMF (16 patients had biventricular disease, 9 had left and 4 had predominantly Right EMF). There were two early deaths (6%) at 5 and 10 days. During a follow up period of 4 weeks to 40 months (mean 25 months) there were no deaths. All patients are asymptomatic with marked improvement of their exercise capacity. Routine echocardiography showed good correction of the hemodynamic lesions in all patients except one who developed recurrence of mitral regurgitation due to dehiscence of the annuloplasty (gortex) band at 3 months postoperatively, which was successfully treated by reoperation. There was no evidence of recurrence of fibrosis in any of the patients during follow up.
Conclusion - It is concluded that targeted surgical treatment of EMF gives good intermediate-term results and should contribute to the treatment of this debilitating neglected disease.