Endomyocardial Fibrosis (EMF)

Endomyocardial Fibrosis (EMF)

Endomyocardial Fibrosis (EMF) is a type of restrictive cardiomyopathy. It is characterised by fibrosis and obliteration of the ventricular cavity, predominantly involving the right ventricle. Isolated involvement of left ventricular inflow region may cause left ventricular inflow and mimic mitral stenosis. But that variety is extremely rare. The common variety involves the right ventricular inflow and body, often obliterating the right ventricular apex. Right ventricular outflow is usually spared. This is the only region of the right ventricle which contracts well in EMF and is clinically evident as right ventricular outflow tract pulsations in the third left intercostal space. Right atrium is enlarged in an aneurysmal fashion. Thrombi and spontaneous echo contrast may be seen in right atrium and ventricle. Severe tricuspid regurgitation is common in EMF. EMF is an important cause of low pressure tricuspid regurgitation.

EMF is seen mostly in tropical countries. It was quite common in Kerala, India, but the prevalence has come down drastically. Sree Chitra Thirunal Institute of Medical Science and Technology Trivandrum has a large surgical experience in EMF. Endocardial resection and tricuspid valve surgery were common in the days when EMF was widely prevalent.