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1. VitellasKM,BennettWF,BovaJG,JohnstonJC, CaldwellJH,MayleJE. Idiopathiceosinophilicesophagitis.Radiology1993;186:789-93.

2. JonesWG,GinsbergRJ.Esophagealperforation:a continuingchallenge.AnnThoracSurg1992;53:53+43.

3. TilanusHW,BossuytP, SchattenkerkME,ObertopI-LTreat-mentofoesophagealperforation:a multivariateanalysis.BrJSurg1991;78:582-5.

4. LeeRG.Markedeosinophiliainesophagealmucosalbiopsies.AmJ SurgPathol1985;9:475-9.

Cine-MRI-AidedEndomyocardectomyin IdiopathicHypereosinophilicSyndrome

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Departmentsof Medicine,Radiology,andCardiothoracicSurgery,EmoryUniversity,Atlanta,Georgia

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with 65Y0 eosinophils. Parasitic infections and allergieswere ruled out, and a final diagnosis of hypereosinophilicsyndrome was made. Treatment with hydroxyurea andsteroids was started, and his leukocyte count declined to19 x 109/L. To define the site and extent of cardiacchamber involvement and plan the surgical approach weperformed magnetic resonance imaging (MRI) of theheart. Multiple slices of the heart were obtained usingboth spin-echo (dark blood) and cine-gradient echo(bright blood) techniques (Fig 1). There was generalizedincreased thickness of the right ventricle with the great-est thickness at the apex and toward the outflow tract.The right-ventricular end-diastolic volume was reducedto approximately 65 mL. cine images, regurgitant jetsemanated from the tricuspid valve into the right atrium.The left ventricle was of normal thickness with no evi-dence of the infiltrative process.

At the time of operation the infiltrative mass was foundto involve the entire distal half of the right ventricle withsome involvement of the proximal right ventricle. Theseptal, posterior mural leaflet of the tricuspid valve andthe papilla~ muscle attached to the free wall werepartially enmeshed in the mass. A part of the mass was

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e through the tricuspid valve, whereas the bulk ofthe mass around the chordae and the papiiiary muscleswas removed through a cardiotomy made as v

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1. WellerPF, BubleyGJ.Theidiopathichypereosinophilicsyn-drome.Blood1994;83:2759-79.

CW Hicks GL. Mitralvalve re-placementin idiopathichypereosinopkiiicsyndrome.Annl%oracSurg1991;51:1007-9:

3. Hem-henWG,Jones‘EL,SmithMD.Aorticand mitralvalvereplacementin idiopathichypereosino@ilicsyndrome.Arm‘!’’horacSurg1998;#6*7&l.

4. LombardiC, RuscortiC, FaggianoP, LanzaniG,ArbustiniE. Successfulreductionof eridomyocardial~brosisin a patient with idiopathichypereosinophiiicsyndronie.Angiology1995;4W4.5+0.

5. Chandra~ SilvermanM,QshinskiJ, Pet@grewR. Diagnosisof cardiacsarcoidrxisaidedby magneticresonanceimaging.Chest(in press).

SubaorticStenosisCausedbyAnomalousPa~iIlarvMuscleof theMitral Valve ‘

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Yutaka Imoto, MD, Hideaki Kado, MD, HiroyukiYasuda, T

Divisionof CardiovascularSurge~, KyushuUniversity,andDepartmentof CardiovascularSurgery,FukuokaChildren’sHospital,Fukuoka,Japan

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01996 by TheSocietyof ThoracicSurgeonsPublishedby ElsevierScienceInc

0003-4975/96/$15.00PIISOO03-4975(96)O0690-X