Parietal Fibroplastic Endocarditis (Loeffler's Disease): Radiological and Surgical Aspects in Connection with a Case Report

Abstract

In a case of parietal fibroplastic endocarditis (Loeffler's disease), changes can be demonstrated by angiocardiography. After almost one year of marked progress, a second angiocardiography demonstrated a progression of the thrombus masses almost completely filling the right ventricle. At surgery, it was possible to remove the granulation masses and find a layer of dissection so that the fibroplastic endocardial membrane could be removed from the entire inside of the right ventricle and over the tricuspid valves, letting only soft myocardium remain. The patient improved rapidly and the results of surgery were confirmed by postoperative angiocardiography.

Loeffler (1936 and 1947) described a disease called endocarditis parietalis fibroplastica. It consisted of a thickening of the parietal endocardium of both ventricles with mural thrombosis but with no changes of the valves. The disease was often accompanied by eosinophilia. Loeffler believed that the disease was related to endocarditis lenta and reported the symptoms as initially diminished exercised tolerance, progressing to intractable congestive heart failure over a period of months or years. The heart could be normal or slightly enlarged, and pleural effusion and emboli to the lungs and spleen have also been reported. Egger (1944) published a case with similar symptoms, also associated with dyspnoea, cyanosis, enlargement of the liver, oedema, ascites and eosinophilia of 15%. Both the right and left ventricles were thickened by thrombi, which in particular severely narrowed the left ventricle. Egger considered that the inflammatory disease of the myocardium and the mural endocardium should be classified as an allergic inflammation and described the disease as endocarditis obliterans. Lennox (1948) presented data on six further cases.

Brink et al. (1965), Hoffman et al. (1955), Weiss-Carmine (1957), Wiener et al. (1957) published reports of Loeffler's disease. Heart cathe-terization has been performed in this disease (Clark et al., 1956). Hurst & Logue stated that it was refractory to therapy, and Wiener found that the response to corticosteroid therapy was “unimpressive”.

A drawing in the Ciba collection of medical illustrations (1969) demonstrates the changes. Pathological, clinical and laboratory data of Loeffler's disease are published but, to the best of our knowledge, the findings at angiocardiography and the results of surgery do not appear to have been reported.