Surgical Treatment of Loffler Endocarditis in an 8-Year-Old Girl
Keywords:Loffler endocarditis, hyper eosinophilic syndrome, thrombosis, pediatrics, surgery
Background: Idiopathic hyper eosinophilic syndrome (HES) is a rare disease characterized by a sustained increase in eosinophilia. Heart involvement is called Loffler endocarditis. Loffler endocarditis is a serious complication of hyper eosinophilia syndrome, which is characterized by a special type of fibrotic endocarditis. Loffler endocarditis is an inflammatory cardiac condition characterized by eosinophilic infiltration in the heart. The overall prognosis for patients with Loffler endocarditis is very poor.
Methods: In this article we report an 8-year-old girl who was diagnosed as having Loffler endocarditis in thrombotic phase and was successfully treated with surgery.
Results: Our patient had a good prognosis during the half-year follow-up. She had no symptoms of heart failure and echocardiography findings were normal.
Conclusion: The cardiac damage occurred in a three-stage process: the necrotic, thrombotic, and fibrotic stages. This unusual but sometimes life-threatening disease is often detected in the late phase, resulting in no curative strategy available to reverse the disease process. The overall prognosis of patients with Loffler endocarditis is very poor. Current treatments include anticoagulation and anti-eosinophils therapy, and surgery only in selected cases. Surgical treatment of HES in adolescents is very rare. The present case illustrates that with well-controlled peripheral eosinophilia, proper surgical treatment in selected patients can improve their prognosis in the near future but long-term follow-up is necessary.
Flanigan MJ, Velez MR, Ruden EA, Lilly SM. 2017. Löffler endocarditis and endomyocardial fibrosis. J Am Osteopath Assoc 117:601.
Nakashima T, Funada A, Kanzaki H, et al. 2014. Massive mobile thrombus in the left ventricle due to Löffler endocarditis complicated with dilated cardiomyopathy. Circ J 78:1992-4.
Niemeijer ND, van Daele PL, Caliskan K, Oei FB, Loosveld OJ, van der Meer NJ. 2012. Löffler endocarditis: a rare cause of acute cardiac failure. J Cardiothorac Surg 7:109.
Sawayama Y, Itoh H, Sakai H, Horie M. 2015. Löffler endocarditis and lacking heart. Intern Med 54:3093.
Yamamoto M, Seo Y, Ishizu T, Aonuma K. 2018. Reversible aortic valve stenosis with Löffler endocarditis. Eur Heart J 39:2332.
Zhuang Q, Zheng ZY, Mao W, et al. 2015. Right ventricular apical obstruction in a patient with hypereosinophilia: Löffler endocarditis. Heart Lung 44:165-9.