Eighty-three patients with endomyocardial fibrosis (EMF) underwent endocardial decortication and atrioventricular valve replacement or repair between December, 1977, and December, 1997. There were 66 (79.6%) female and 17 (20.4%) male patients, ranging in age from 4 to 59 years (mean, 31). Thirty-seven (44.5%) had biventricular disease 134 (41.0%) had disease of the right ventricle alone and 12 (14.5%) had EMF confined to the left ventricle. All were in functional class III or IV (New York Heart Association classification). Sixty-eight (81.9%) patients survived the operation and were followed-up for periods of time ranging from 1 month to 17 years. The total follow-up time was 6,290 patient/months (mean, 92 months). There were 15 late deaths but in 6 the cause was not related to the underlying disease. Four (5.8%) patients presented recurrence of the fibrosis and were reoperated and in 6 (8.8%) EMF appeared in the other ventricle. Five (7.3%) patients were reoperated to replace either a valve prosthesis or a native valve which had been preserved during the first procedure. Only 24 (45%) of the 53 living patients are in functional class I or II. The actuarial probability of survival at 17 years, including operative mortality, was 55%. In conclusion, surgical treatment of EMF should be considered a palliative procedure because surgery does not stop the progressive nature of the disease. However, surgical therapy is recommended for patients with EMF and heart failure as it is the only hope for them.
Endomyocardial fibrosis; Endomyocardial fibrosis
