Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2011;64:713 - Vol. 64 Num.08 DOI: 10.1016/j.rec.2011.02.006

Schistosomiasis and Tropical Endomyocardial Fibrosis With Pulmonary Hypertension

Ferran Gran a,, Dimpna C. Albert a, Antonio Moreno b

a Servicio de Cardiología Pediátrica, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Servicio de Neumología Pediátrica, Hospital Universitario Vall d’Hebron, Barcelona, Spain

Article

An 11-year-old black girl from Equatorial Guinea was admitted to our hospital to investigate fatigue, hepatomegaly, and ascites. Echocardiography showed severe left atrial dilation, normal systolic function, and severe dilation of the right chambers. The pulmonary pressure, estimated by the tricuspid regurgitation, was 100 mmHg. A hemodynamic study was performed and confirmed systemic pulmonary pressure with pulmonary resistance of 23 UW/m2, which did not change with oxygen and nitric oxide therapy. Additional testing showed a normal hemogram and positive stool culture for Schistosoma intercalatum and S. haematobium.

The diagnosis was restrictive cardiomyopathy and pulmonary hypertension due to schistosomiasis.

Medical treatment was started with antiparasitic therapy, diuretics, and systemic and pulmonary vasodilators, but there was no apparent response. During the evolution of her condition, the patient presented an episode of left hemiparesis secondary to cerebral thromboembolism during an episode of atrial fibrillation.

Four years after the diagnosis, she underwent successful cardiopulmonary transplantation. The figures show a macroscopic section of the ventricle at the level of the papillary muscles in which the ventricular endocardium has a pearly appearance, corresponding to endomyocardial fibrosis (EMF) (Figure 1), a microscopy view with Masson trichrome stain showing an area of acellular fibrosis (Figure 2), and a section of the right atrium (Figure 3).

Figure 1.

Figure 2.

Figure 3.

Corresponding author: fgranipina@gmail.com

1885-5857/© 2011 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

Cookies
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
Cookies policy
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.