Surgical excision of fibrotic endocardium combined with tricuspid valve replacement and pacemaker implantation can provide substantial symptomatic improvement in patients with severe right ventricular endomyocardial fibrosis.
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May support surgical therapy in severe right ventricular endomyocardial fibrosis; leaves open need for prospective validation before broader adoption.
A 58-year-old African man from Uganda was referred to our hospital for dysnea on exertion, ascites, splenomegaly, and peripheral edema. ECG revealed bradycardia with third-degree atrioventricular block. chest CT scan (Fig. 1) showed right ventricular thickening with calcifications, stenosis at outlet portion and obliteration of the apex, dilated atrium. Operative excision of the fibrotic endocardium was made with replacement of the tricuspid valve and implantation of pacemaker (Fig. 2) . Microscopically, the involved endocardium demonstrates a thick layer of collagen tissue on top of a layer with calcifications. The patient was discharged after 9 days with substantial symptomatic improvement. Chest CT scan showing endocardium right ventricular thickening with calcifications, dilated atrium. Operative view of right ventricle through tricuspid valve. Endocardial calcific deposits and severe fibrosis extend from the inflow portion to the ventricle apex. The tricuspid valve is involved.
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Hornero et al. (2001) studied this question.
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