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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 132-138, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AD Jatene, LF Moreira, NA Stolf, EA Bocchi, P Seferian Jr, PM Fernandes and H Abensur
Dynamic cardiomyoplasty has been reported in the treatment of severe
myocardial failure. In this investigation significant improvement of left
ventricular function with dynamic cardiomyoplasty was demonstrated in
patients with dilated cardiomyopathy or Chagas' disease for more than 1
year of follow-up. Thirteen patients with advanced heart failure who were
in New York Heart Association class III or IV were operated on. There were
no operative deaths. Patients were followed up for a mean of 11.5 months,
and two patients died during the late follow-up period. Five of nine
patients observed long term are in New York Heart Association class I,
three in class II, and one in class III. At 3 months of follow-up, Doppler
echocardiography demonstrated that left ventricular segmental wall
shortening increased from 11.4% +/- 2.3% to 16.4% +/- 3.9% (p less than
0.01), and left ventricular stroke volume from 23.9 +/- 5.7 to 34.4 +/- 10
ml (p less than 0.01). Radioisotopic left ventricular ejection fraction
improved from 20.9% +/- 3.3% to 25.4% +/- 7.7% (p = 0.06), and its better
increases occurred in patients with lesser left ventricular end-diastolic
dimensions. Cardiac catheterization showed that left ventricular stroke
work index increased from 14.6 +/- 3.8 to 23.7 +/- 6.7 gm.m/m2 (p less than
0.01), whereas pulmonary wedge pressure decreased from 24.8 +/- 3.7 to 17.2
+/- 5.8 mm Hg (p less than 0.01). At 6 and 12 months of follow-up, all the
preceding values remained essentially unchanged. Thus cardiomyoplasty
improves left ventricular function and may halt the steady evolution of
severe cardiomyopathies.
ARTICLES
Left ventricular function changes after cardiomyoplasty in patients with dilated cardiomyopathy
Instituto do Coracao da Faculdade de Medicina da Universidade de Sao Paulo, Brazil.
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