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Two patients with marked ventricular endocardial fibroelastosis and evidence of obstruction of cardiac lymphatic vessels lend support to the hypothesis derived from dog experiments that chronic impairment of the cardiac lymph flow leads to endocardial fibroelastosis. One patient, aged 52 years, developed chronic myocarditis 7 years prior to her death. The other patient, a 6-month-old infant, had congenital lymphangiectasis with diffuse involvement of the gastrointestinal tract, lymph nodes, and heart. Microscopic examination of the hearts revealed markedly dilated and tortuous lymphatic channels throughout the myocardium and epicardium, a finding present with long-standing obstruction to lymph flow. It is concluded that chronic obstruction of cardiac lymph flow, from whatever cause, results in ventricular endocardial fibroelastosis.

The Relationship between Human Endocardial Fibroelastosis and Obstruction of the Cardiac Lymphatics