Fibro-elastosis of the heart in adolescence.

Heart failure in young subjects, when unaccompanied by signs of congenital abnormality or rheumatic disease, can pose a diagnostic problem that may remain unsolved even after careful pathological study. A proportion of such cases in infancy is caused by endocardial fibro-elastosis (Prior and Wyatt, 1950; Dennis et al., 1953), and it has even been suggested that this is one of the commonest types of fatal heart disease in the first year of life (Blumberg and Lyon, 1952). Diagnosis during life is often difficult and the possibility of survival into late childhood or adolescence must be considered when any case of heart disease of unknown etiology is discovered at this age. Gowing (1953) and Elster et al. (1955) have both stated that such cases are not to be found, and that their absence in this intermediate age group suggests that the infantile condition is not etiologically related to any form of idiopathic heart disease in adults. However, Thomas et al. (1954) have published a group of five acceptable and uncomplicated cases, ranging in age from 5-16 years, that were pathologically indistinguishable from the infantile form of the disease, and occasional reports of others, probably similar, have appeared during the last fifty years which suggest that, though rare, survival may occur (Table I). It is interesting that the cases described by Thomas et al. had all previously been reported as examples of "idiopathic" heart disease.