Severe left endomyocardial fibrosis.Echocardiography shows thickening of endocardium at the apex of the left ventricle that has a spherical shape and has reduced longitudinal dimension and thickening of the anterior leaflet of the mitral valve; left atrial dilatation is associated with both mitral regurgitation and reduced ventricular compliance. Notice the dilatation of the right cavities caused by elevation in pulmonary pressures.