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Virchows Archiv

, Volume 453, Issue 3, pp 233–241 | Cite as

Endomyocardial fibrosis: pathological and molecular findings of surgically resected ventricular endomyocardium

  • Silvia D’Andretta IgleziasEmail author
  • Luiz Alberto Benvenuti
  • Fiorella Calabrese
  • Vera Maria Cury Salemi
  • Ana Maria Gonçalves Silva
  • Elisa Carturan
  • Sergio Almeida de Oliveira
  • Gaetano Thiene
  • Thales De Brito
Original Article

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.

Keywords

Endomyocardial fibrosis Immunohistochemistry Lymphatic vessels Surgical pathology Polymerase chain reaction 

Notes

Acknowledgements

The authors would like to thank Marcia Martins Reis for her excellent technical assistance in immunohistochemistry. This work was partially supported by the Fundação de Amparo a Pesquisa do Estado de São Paulo, process number 03/08052-8, and LIM 06, University of São Paulo Medical School.

Conflitct of interest statement

We declare that we have no conflict of interest.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Silvia D’Andretta Iglezias
    • 1
    Email author
  • Luiz Alberto Benvenuti
    • 2
  • Fiorella Calabrese
    • 3
  • Vera Maria Cury Salemi
    • 2
  • Ana Maria Gonçalves Silva
    • 4
  • Elisa Carturan
    • 3
  • Sergio Almeida de Oliveira
    • 2
  • Gaetano Thiene
    • 3
  • Thales De Brito
    • 4
  1. 1.Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
  2. 2.Heart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
  3. 3.Department of PathologyUniversity of Padua Medical SchoolPaduaItaly
  4. 4.LIM 06, Institute of Tropical MedicineUniversity of São Paulo Medical SchoolSão PauloBrazil

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