An innovative technique for the relief of right ventricular trabecular cavity obliteration in endomyocardial fibrosis

Abstract

Endomyocardial fibrosis (EMF) mainly affects persons from Africa, South America, and Asia. 1 The pathogen- esis of this condition remains unknown. In advanced forms, EMF produces marked disability and carries a poor prognosis. Although there is consensus about the potential value of surgical intervention in symptomatic patients, there is still debate regarding the exact timing and the surgical technique to be used. 2,3 EMF is characterized by endocardial fibrosis affecting the inflow tract and the apex of 1 or both ventricles, commonly involving the atrioventricular valves. The right ventricle is affected in most cases. 4 In severe forms, marked reduction of ventricular volume is thought to be due to the presence of a plug of fibrous tissue involving both the trabecular part and the apex. 5 We here describe a new mechanism for apical obliteration of the right ventricle in EMF. The concept was used to evolve and apply a new surgical technique to increase ventricular volume, improve contractile function by releasing the myocardium and making use of viable myocardium in the obliterated area, and correct the tricuspid regurgitatio