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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017



The method we used was to identify and select cases of

EMF from patients attending our echocardiography laboratory

using predefined features and definitions. All images relate to

advanced forms of EMF, which were available in the hospital

setting. We did not see mild or early forms of the disease and

speculate that population-based studies are more appropriate for

reporting these types of EMF.


As we recognised only 23 cases of EMF during the course of

eight years, we infer that the disease is rare in Sudan and that

only isolated cases are prevalent. Consequently, a study of this

nature will help improve the awareness of physicians to diagnose

this disease.

The basic diagnostic echocardiographic features are shown in

Figs 1 to 3. The images of apical and ventricularwall fibrosis together

with huge atria should alert the investigator to the possibility of

EMF. The presence of moderate-to-severe atrioventricular valve

regurgitation and obliterated ventricles should provide further

confirmation of the diagnosis (Fig. 1A, Fig. 2B, C).

Fig. 5.

Endocardial fibrous shelf. A is PLAX, B is AP4, and C and D are modified APLX views from three different patients (B and

D from same patient), with left ventricular EMF showing thickened endocardium spreading over the recess between the

posterior papillary muscle and the posterior mitral valve leaflet, engulfing the leaflet and forming an immobile endocardial

fibrous shelf (S). The anterior mitral valve leaflet although moderately thickened, moves freely, while the whole mitral struc-

ture appears reduced to a single leaflet valve.