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....