Successful surgical treatment of two patients with eosinophilic endomyocardial disease.

Cardiac surgery to treat severe heart failure was of benefit to two patients with endomyocardial disease and hypereosinophilia-eosinophilic endomyocardial disease. Both patients had severe biventricular fibrosis with mitral and tricuspid regurgitation. One had predominant right ventricular disease and was treated by right ventricular endocardectomy with tricuspid and mitral xenograft valve replacement. The second patient's main haemodynamic problem was considered to be mitral regurgitation. His mitral valve was replaced by a Starr-Edwards prosthesis; endocardectomy was not performed. Though both patients had toxic confusional states for several weeks postoperatively there was distinct symptomatic and objective evidence of improvement which has been maintained for over 16 months. Previous reports of surgical treatment of 22 patients without eosinophilia (all of whom had endomyocardial resection) and three other patients with eosinophilia have shown equally encouraging results. There has been no evidence of recurrence or progression of heart damage in follow-up periods of up to seven years. It is concluded that cardiac surgery is an important advance in the treatment of endomyocardial disease in patients with or without an eosinophilia.