de Oliveira S A, Pereira Barreto A C, Mady C, Dallan L A, da Luz P L, Jatene A D, Pileggi F
Instituto do Coração, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Brazil.
J Am Coll Cardiol. 1990 Nov;16(5):1246-51. doi: 10.1016/0735-1097(90)90561-3.
Endomyocardial fibrosis has been treated surgically for many years. For complete removal of fibrosis from both ventricles by the classic technique, each atrioventricular (AV) valve was removed and replaced with a prosthesis. Relapse of endomyocardial fibrosis has not been observed after surgical correction. Reoperations have been carried out because of complications of valve prostheses. A new surgical technique for removal of ventricular fibrous tissue with preservation of the mitral and tricuspid valves was used in nine consecutive patients with endomyocardial fibrosis. Initial results show a reduction of pulmonary hypertension, mean right and left atrial pressures and end-diastolic pressures in both ventricles. Tricuspid annuloplasty was performed in seven patients and mitral annuloplasty in five. No valve prosthesis was used. There was no death and New York Heart Association functional class improved from class III or IV in the preoperative period to class I or II in the postoperative period. These data suggest that resection of endocardial fibrous tissue can be indicated early in the clinical course and performed with preservation of the AV valves.
心内膜心肌纤维化的外科治疗已有多年历史。采用经典技术要完全清除两个心室的纤维化，需切除每个房室（AV）瓣并用人工瓣膜进行置换。手术矫正后未观察到心内膜心肌纤维化复发。因人工瓣膜并发症进行了再次手术。一种保留二尖瓣和三尖瓣的心室纤维组织切除新手术技术应用于9例连续的心内膜心肌纤维化患者。初步结果显示肺动脉高压、平均右心房和左心房压力以及两个心室的舒张末期压力均有所降低。7例患者进行了三尖瓣环成形术，5例进行了二尖瓣环成形术。未使用人工瓣膜。无死亡病例，纽约心脏协会心功能分级从术前的III级或IV级改善至术后的I级或II级。这些数据表明，心内膜纤维组织切除术可在临床病程早期进行，并保留房室瓣。
