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

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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.

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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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Authors and Affiliations

  1. Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil

    Silvia D’Andretta Iglezias

  2. Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

    Luiz Alberto Benvenuti, Vera Maria Cury Salemi & Sergio Almeida de Oliveira

  3. Department of Pathology, University of Padua Medical School, Padua, Italy

    Fiorella Calabrese, Elisa Carturan & Gaetano Thiene

  4. LIM 06, Institute of Tropical Medicine, University of São Paulo Medical School, São Paulo, Brazil

    Ana Maria Gonçalves Silva & Thales De Brito

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  1. Silvia D’Andretta Iglezias
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  2. Luiz Alberto Benvenuti
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Correspondence to Silvia D’Andretta Iglezias.

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Iglezias, S.D., Benvenuti, L.A., Calabrese, F. et al. Endomyocardial fibrosis: pathological and molecular findings of surgically resected ventricular endomyocardium. Virchows Arch 453, 233–241 (2008). https://doi.org/10.1007/s00428-008-0652-3

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  • DOI: https://doi.org/10.1007/s00428-008-0652-3

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