Coronary arteriographic patterns in right sided endomyocardial fibrosis associated with schistosomiasis

ABSTRACT

Selective coronary cineangiography was performed in 7 patients [4 males and 3 females, mean age was 35 +/- 10 years] with right-sided endomyocardial fibrosis [EMF] to study the coronary arterial patterns in this disease. The diagnosis of EMF was confirmed by typical clinical, radiologic, echocardiographic, hemodynamic, and angiographic features of right-sided EMF. They all had Schistosoma mansoni infestation with schistosomal hepatic fibrosis. Epicardial coronary arteries were free of disease. However, the following abnormalities were seen on coronary arteriography Vascular blush was unexceptionally present in every patient within the distribution of right ventricular and posterior descending branches of right coronary artery [RCA]; right/left myocardial contrast washout time ratio was markedly increased [range 1.6 - 2.4]; abnormal course of RCA running almost transversely throughout its whole course; hugely dilated right atria received proportionately rich blood supply by stout tortuous and elongated branches mainly from the circumflex and sinus node arteries. Atrial branches from RCA contributed less significantly. RCA was dilated and dominant in 6/7 patients. Left coronary system was absolutely normal. Extensive fibrosis of the right ventricle and the hugely dilated right atrium associated with right sided EMF lead to secondary changes in the coronary arterial patterns of these chambers