LEFT-VENTRICULAR REDUCTION (BATISTA) - A NEW SURGICAL OPTION IN DILATED CARDIOMYOPATHY

Cardiac transplantation remains the standard treatment for severe card iomyopathy resistant to medical therapy. However, new techniques may h elp to put this off. Two patients with dilated cardiomyopathy were tre ated surgically since October 1996, one aged 48 and the other 52. They were in NYHA Class IV and one was dependant on inotropic drugs. Both had relative or absolute contra-indications to tranplantation. The lef t ventricular end diastolic dimensions were over 70 mm with mild mitra l regurgitation and fractional shortening of less than 12 %. Coronary angiography was normal. They were operated in October 1996 and January 1997. The procedure consisted of correction of mitral regurgitation ( annuloplasty) and of reduction of left ventricular volume by a triangu lar resection from the apese to the base of the heart. At histological examination, the resected myocardium measured 11 to 13 cm long and 5 to 7 cm at its base. The two patients were discharged from hospital af ter 45 and 30 days. There were no clinical signs of cardiac failure. F ollow-up investigations showed a marked decrease in ventricular volume s, the end diastolic dimensions changing from 70 to 52 mm in the first , and from 76 to 54 mm in the second patient. The corresponding values of fractional shortening increased from 11 to 20 % and from 6 to 17 % . Left ventricular volumes decreased from 328 mL (end diastole) and 25 9 mL (end systole) to 140 mL and 74 mL in the first case, and from 300 mL (end diastole) and 280 mL (end systole) to 122 mL and 83 mL respec tively in the second case. The ejection fraction increased from 20 to 40 % and from 10 to 32 %. These preliminary results show that the theo retical advantages of this surgical technique correspond to a practica l reality. Larger series of patients are required to determine the opt imal indications.