Between April 1988 and January 1991 we operated on 25 consecutive patients with endomyocardial fibrosis (EMF) with an approach to preserve the atrioventricular valves. Nineteen patients were females and six males. Their ages ranged from 11 to 5 years, with an average of 40.6 years. Seventeen patients had biventricular involvement, six had involvement of the left ventricle and only two patients had an isolated lesion of the right ventricle. All of them were in advanced stage of heart failure, 19 of which were in class IV of the NYHA, and six were in class III. Prior to the operation, tricuspid insufficiency was present in 24 patients and mitrai insufficiency was present in 22 patients. All the patients were operated on with the support of extracorporeal circulation and systemic hipothermia of 28ºC. Intermitent aortic cross-clamping was used so as to permit better exposition of the ventricular cavities. The fibrosis of the right ventricle was always removed through the tricuspid valve, while the fibrosis of the left ventricle was removed through a small apical left ventriculotomy in all the patients. An DeVega's annuloplasty of the tricuspid valve was necessary in all the patients with tricuspid insuffiency. On the other hand, seven patients had spontaneous correction of the ventricle insufficiency after the removal of the fibrosis of the left ventricle, while fifteen needed an annuloplasty. There was one (4.0%) in-hospital death and no late deaths. All patients experienced clinical improvement and are in NYHA functional class I or II.
endomyocardial fibrosis; heart valves; cardiomyopathies