Surgical treatment of endomyocardial fibrosis.

Forty-six patients with endomyocardial fibrosis underwent endocardiectomy and replacement of tricuspid, mitral, or both atrioventricular valves between April, 1981, and October, 1984, at the Sree Chitra Tirunal Institute, Kerala State, India, which has a high incidence of the disease. Six patients were in New York Heart Association Functional Class III and 40 patients in Class IV. The operative mortality within 30 days of the procedure and late mortality during the first two years postoperation were 21.7% and 13%, respectively. Age under 15 years was a significant correlate of operative mortality (p = .05). Non-fatal thromboembolic episodes occurred in 6 patients during the two years of postoperative observation. The life table estimate of survival inclusive of operative mortality at two years was 67%. Despite high operative mortality, endocardiectomy with atrioventricular valve replacement is advisable for functionally disabled patients with endomyocardial fibrosis whose prognosis otherwise is dismal.