Right sided restrictive cardiomyopathy in Egyptian peasants with hepatosplenic schistosomiasis: a Retrospective 5- year study

ABSTRACT

Endomyocardial Fibrosis [EMF] is a common disease in the humid zones of tropical Africa- Recognition of cases outside the tropical zone has been reported with increasing Interest. We report our experience with 30 Egyptian peasants who all had infection with schistosoma. Laboratory investigations, 12-lead electrocardiography and pericardiocentesis were performed in all patients. Pericardial biopsy was performed in some patients. All patients had evidence of infection with schistosoma mansoni, schistosomal hepatic fibrosis. splenomegaly and ascites. All patients had markedly congested neck veins with positive kussmaul's sign in some patients. All patients had no eosinophilia. Atrial fibrillation was detected in 24 patients. Detailed echocardiographic study showed obliteration of the right ventricle [RV], apical RV firbrosis, varying degrees of exudative pericardial effusion in all patients. No extension of fibrosis into RV outflow tract. No fibrosis in left side of heart. Hugely dilated right atrium [RA] with RA spontaneous echo contrast detected in all patients and FM thrombi in only 10 patients. Normal size pulmonary artery without pulmonary hypertension. Minimal to mild tricuspid regurgitation was detected in all patients by Doppler echocardiography. In conclusion, right-sided restrictive card iomyopathy is a special form of EMF detected only in Egyptian peasants without eosinophilia. It always, involved the right side of the heart. Calcification extended to the RV outflow tract in some cases