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Endomyocardial fibrosis in Mozambique

A 46-year-old woman from north of Maputo in Mozambique, an area endemic for endomyocardial fibrosis, presented with a giant ascites estimated at about 45 liters with an abdominal girth of 175 cm (Fig. 1A, B), secondary to endomyocardial fibrosis, largely predominant on the right ventricular inflow tract, with no coaptation of the tricuspid valve (Fig. 1C), leading to a severe insufficiency (Fig. 2A). The infundibulum is spared from this fibrotic process (Fig. 2B). Unfortunately, the treatment is only medical without possibility of systemic venous-to-pulmonary artery shunt because of the associated left ventricular diastolic dysfunction. Endomyocardial fibrosis is a rare restrictive cardiomyopathy, without environmental or genetic causes found, affecting mainly young people belonging to the poorer sections of the society in certain tropical areas. This clinical aspect with disproportioned ascites is one of mysterious aspects of the disease. Some authors defend the hypothesis of a systemic disease with endomyocardial and peritoneal fibrosis.