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
