title: Endomyocardial fibrosis: pathological and molecular findings of surgically resected ventricular endomyocardium.
abstract: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy of unknown etiology prevalent in tropical regions affecting the inflow tract and apex of one or both ventricles, which show fibrous thickening of the endocardium and adjacent myocardium. Surgical treatment is recommended for patients in functional classes III or IV (New York Heart Association). The gross and histological features of the heart have been comprehensively studied in autopsies, but studies in surgical samples are still lacking. Histological and immunohistochemical features of EMF in surgical samples collected from 32 patients were described and correlated with clinical data. Polymerase chain reaction (PCR) and reverse transcription-PCR, performed on formalin fixed endomyocardial samples, were used retrospectively to detect genomes of certain cardiotropic viruses and Toxoplasma gondii. Ventricular endocardium was thickened by superficial acellular hyaline collagen fibers type I and III, with predominance of the former type. Besides fibrosis, a chronic inflammatory process and an anomalous lymphatic rich vascular pattern were observed in the deep endocardium, connected to the terminal coronary circulation of the myocardium, which might be an important pathological finding concerning EMF pathogenesis. Molecular analysis of the endomyocardium revealed high incidence of cardiotropic infective agents (6/12, 50%); however, their role in the disease pathogenesis is still controversial.
authors.affiliation: Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil. silviaiglezias@uol.com.br
authors.forename: Silvia D'Andretta
authors.initials: SD
authors.lastname: Iglezias
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Benvenuti
authors.forename: Fiorella
authors.initials: F
authors.lastname: Calabrese
authors.forename: Vera Maria Cury
authors.initials: VM
authors.lastname: Salemi
authors.forename: Ana Maria Gonçalves
authors.initials: AM
authors.lastname: Silva
authors.forename: Elisa
authors.initials: E
authors.lastname: Carturan
authors.forename: Sergio Almeida
authors.initials: SA
authors.lastname: de Oliveira
authors.forename: Gaetano
authors.initials: G
authors.lastname: Thiene
authors.forename: Thales
authors.initials: T
authors.lastname: De Brito