Loeffler Endocarditis Treatment & Management

Updated: Feb 17, 2015
  • Author: Sohail A Hassan, MD; Chief Editor: Richard A Lange, MD, MBA  more...
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Treatment

Medical Care

Perform serial CBC counts.

Symptomatic relief is achieved by routine cardiac therapy, including diuretics, digitalis, afterload reduction, and anticoagulation, as indicated by Weller et al and Parillo et al. [24, 31]

Treatment with low-dose imatinib causing rapid regression of both eosinophilic proliferation and endomyocardiopathy is described by Cools et al, Vandenberghe et al, and Rotoli et al. [18, 19, 20]

Early phases of the disease have been treated with immune suppressant and cytotoxic medications with varying degrees of success.

Corticosteroids appear to be beneficial in acute myocarditis, as reported by Uetsuka et al, among others. [42] Together with cytotoxic drugs, including hydroxyurea, corticosteroids may prolong survival substantially, as reported by Weller et al, Parillo et al, and Arnold et al. [24, 31, 39]

Interferon therapy also has been reported by Butterfield et al as having some success. [43]

Outpatient follow-up includes close follow-up observation for recurrence of symptoms of heart failure. Serial echocardiograms to evaluate ejection fraction are also helpful for titration of medications.

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Surgical Care

Once fibrosis ensues, surgical therapy may have a positive impact on palliation of symptoms.

Dubost et al performed the first endocardiectomy in endomyocardial fibrosis, which consists of decorticating the fibrosed endocardium in a manner similar to resection of constricting densely fibrotic pericardium.

In 150 published cases of surgical therapy of endomyocardial fibrosis and eosinophilic myocarditis, an operative mortality rate of 15-29% is reported, with AV block requiring a permanent pacemaker as a common complication.

Endocardiectomy is directed toward the predominant location of the restrictive process.

The mitral and tricuspid valves may be subject to replacement or repair, depending on the involvement of the subchordal apparatus.

Early surgery is assisted by the fact that fibrous septa may not have extended into the adjacent myocardium.

When the restrictive process is advanced, in individuals with congestive heart failure refractory to medical therapy, the only potential approach is endocardiectomy.

The extent to which fibrosis recurs postoperatively is not known.

In 2006, Tanaka et al reported endomyocardial resection as well as mitral valve replacement in a patient with severe restrictive myocardial disease and mitral leaflets involvement; however, the patient died 3 months later of cerebral infarction. [44] Jategaonkar et al reported a similar patient with a 4-year survival until last follow up. [45]

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