Partial Left Ventriculectomy in Patients with Dilated Failing Ventricle

Kawaguchi, Akira T.; Bergsland, Jacob; Ishibashi‐Ueda, Hatsue; Ujiie, Toshimi; Shimura, Shinichiro; Koide, Shirosaku; Salerno, Tomás A.; Batista, Randas J.V.

doi:10.1111/j.1540-8191.1998.tb01094.x

Cited by 27 publications

(31 citation statements)

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“…Other indicators for a worse outcome included fractional shortening <5% and duration of preoperative symptoms >9 years. Individual centers have also implicated degree of postoperative mitral regurgitation [56]and extent of interstitial fibrosis [57]as adverse factors affecting outcome. However, it still remains difficult to predict which candidates are virtually guaranteed a successful outcome.…”

Section: Reconstruction For Dilated Cardiomyopathymentioning

confidence: 99%

Ventricular Reconstruction Surgery for Congestive Heart Failure

2004

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The significant increase in the prevalence of heart failure in the United States has made this disease a major health problem. The continued shortage of donor organs has prevented heart transplantation from becoming an effective solution for the treatment of end-stage heart failure, and as a result, surgical treatments for heart failure have been reexamined. Surgical therapies represent the evolution of conventional operations, such as coronary artery bypass surgery, and the application of the more novel left ventricular (LV) reconstruction operations which address the geometry of the LV, the important component in the failing heart.

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Section: Reconstruction For Dilated Cardiomyopathymentioning

confidence: 99%

Ventricular Reconstruction Surgery for Congestive Heart Failure

2004

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“…5 They also compared NYHA class I patients with those of NYHA class II, III or IV and found no difference between the groups with respect to preoperative LVDd, postoperative LVDd or absolute reduction of LV end-diastolic diameter. Kawaguchi et al described poor results of extended partial left ventriculectomy concomitant with excision of the papillary muscle and mitral valve followed by implantation of a bioprosthesis, 6 suggesting that greater volume reduction and less mitral regurgitation does not necessarily improve function. They also reported that patients having less severe interstitial fibrosis of the excised myocardium showed a better prognosis than patients with more severe fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Partial Left Ventriculectomy in Association With Dilated Cardiomyopathy

Nakamoto

Oku

Fukuhara

et al. 2002

Circ J

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artial left ventriculectomy was introduced by Batista et al 1 as a surgical procedure to treat end-stage dilated cardiomyopathy (DCM). The operation was successfully performed according to Batista's surgical procedure on a 19-year-old male presenting with DCM. We report the postoperative performance of his left ventricle (LV) estimated by echocardiography. To date, this patient has survived longer than any other patient in Japan who has undergone partial left ventriculectomy. Case ReportA 19-year-old male was admitted to hospital in August 1996 with the chief complaint of peripheral edema and orthopnea caused by deterioration of DCM despite of 6 years medical treatment. On admission, the patient's blood pressure was 96/54 mmHg and he presented with functional class IV heart failure according to the New York Heart Association (NYHA). A chest roentgenogram revealed an increased cardiothoracic ratio (0.59) and pulmonary congestion (Fig 1). An ECG showed LV hypertrophy, inverted T wave in leads II, III, aVF and V6, ST depression in V5 and V6, and frequent premature ventricular beats (Fig 2). The LV dimension measured by echocardiography was 115 mm in end-diastole and 112.7 mm in end-systole, and the LV fractional shortening (LVFS) was 0.03. Blood tests and liver and kidney functions were normal.Treatment was begun with dopamine and furosemide. On the fourth day following admission, echocardiography revealed thrombi in the LV, and on the fifth day, the patient experienced sudden transient right hemiparesis and motor aphasia. Brain computed tomography revealed a hemorrhagic infarction in the left basal ganglia, but the hemiparesis and motor aphasia completely recovered. Although repeated echocardiography and MRI of the LV did not clearly reveal the thrombi seen previously, residual thrombi were suspected. In order to avoid a recurrence of the thromboembolism and to improve LV function, thrombectomy was indicated and concomitant partial left ventriculectomy was considered desirable. Cardiac catheterization was performed in November 1996, 1 week prior to surgery, and revealed that the pulmonary pressure was 19/9 mmHg (mean 16 mmHg) and pulmonary wedge pressure was 12/9 mmHg (mean 8 mmHg). Preoperatively, the LV diastolic dimension (LVDd) was 72.6, the systolic dimension (LVDs) was 69.2, and the LVFS was 0.08. The patient's heart function had improved preoperatively from NYHA class IV to class II with angiotensin converting enzyme inhibitor and -blocker treatment.An operation was performed in December 1996 using standard cardiopulmonary bypass with moderate hypothermia. Cold blood cardioplegia and topical cooling ensured myocardial protection. Following aortic clamping, entry to the LV was made at the apex and approximately 12×4 cm of the LV free wall was resected between the obtuse marginal branch and the terminal left circumflex branch according to Batista's procedure. Mural thrombi were not observed. The LV was repaired using a 3-0 polypropylene continuous suture in 1 layer and cardiopulmonary bypass was discontinued....

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“…O emprego da ventriculectomia parcial esquerda, como uma alternativa ao transplante cardíaco, no tratamento de pacientes portadores de cardiomiopatia dilatada tem sido investigado com grande interesse em centros nacionais e internacionais, cuja experiência inclui, atualmente, mais de mil casos operados em todo o mundo (2,4,(6)(7)(8)(9)(10)(11)13,15) . A interpretação dos resultados obtidos em vários estudos, no entanto, é limitada pela existência de ventricular em 5 anos de seguimento da ventriculectomia parcial esquerda no tratamento da cardiomiopatia dilatada.…”

Section: Comentáriosunclassified

“…Rev Bras Cir Cardiovasc 2001; 16(4): 275-88. Meses de Seguimento % afecções de diversas etiologias nas séries relatadas (2,(7)(8)(9)(10)(11)15) e pela associação da redução cirúrgica do volume do VE a outros procedimentos, além da correção da insuficiência valvar mitral (2,(7)(8)(9)(10)15) .…”

Section: Comentáriosunclassified

“…Vários estudos demonstram a melhora da função ventricular esquerda e dos sintomas de insuficiência cardíaca após a realização deste procedimento (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) . Por outro lado, incidências elevadas de óbitos relacionados à progressão da insuficiência cardíaca ou a arritmias têm sido relatadas nos primeiros meses de seguimento pós-operatório, na maioria dos estudos clínicos (2)(3)(4)(5)7,12,14) , representando grande limitação para o emprego rotineiro desta técnica.…”

Section: Rbccv 44205-556 Introduçãounclassified

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