Evolução clínica de pacientes submetidos à ventriculectomia esquerda parcial / Outcome of Patients Submitted to Partial left Ventriculectomy

OBJECTIVE: To assess the efficacy of partial left ventriculectomy as a treatment for patients with end-stage heart failure. METHODS: From February to June 1995, 7 patients with end-stage heart failure underwent partial left ventriculectomy. Subsequently, patients underwent clinical evaluation every 2 months, and 2-dimensional echocardiography at the 6th and 12th months after cardiac surgery. All patients were given digitalis and diuretics at conventional doses, and captopril or enalapril at maximal tolerated doses. RESULTS: Two (28) patients died; 1 from cardiac arrhythmia associated with gastrointestinal hemorrhage, and the other suddenly. One (14) patient developed an embolic cerebrovascular accident. Four (57) patients were hospitalized for congestive heart failure; all of them had either decreased the daily dose of captopril or enalapril or discontinued the drugs by themselves. Twelve months after ventriculectomy, left ventricular ejection fraction values were greater and left ventricular diastolic dimension and functional class values lower than those found before cardiac operation. CONCLUSION: Beneficial effects of partial left ventriculectomy are observed one year after the surgical procedure. This technique, therefore, can be useful for the treatment of patients with end-stage heart failure.

Experiência inicial com a ventriculectomia parcial esquerda no tratamento da insuficiência cardíaca terminal / Initial experience with partial left ventriculectomy as a treatment for end-stage heart failure

PURPOSE: To evaluate the efficacy of left ventriculectomy, on a short term basis, as a treatment for patients with end-stage heart failure. METHODS: From February to June 1995, 7 patients with end-stage heart failure underwent partial left ventriculectomy. Before the surgical procedure, 7 (100) patients were in functional class IV. Three (42) patients needed inotropic support for hemodynamic stability. The mean daily dose of furosemide was l48.67 +/- 128.27 mg, of captopril 87.50 +/- 95.20 mg and of digoxin 0.23 +/- 0.04. Mean left ventricular diastolic dimension determined by 2-D echocardiography was 78.29 +/- 12.63 mm, mean left ventricular ejection fraction, determined by radionuclide ventriculography, was 0.15 +/- 0.05 whereas mean transpulmonary gradient and pulmonary vascular resistance in Wood units, determined by right heart catheterization, were 16.80 +/- 8.80 and 6.57 +/- 3.22, respectively. RESULTS: Sixty days after the surgery, the mean functional class was 1.71 +/- 0.48 (p = 0.009), the mean left ventricular diastolic dimension 64.67 +/- 11.41 mm (p = 0.02) and the mean left ventricular ejection fraction 0.22 +/- 0.04 (p = 0.02). CONCLUSION: The left ventriculectomy is a promising treatment for patients with end-stage heart failure.

Objetivo - Avaliar a eficácia da ventriculectomia parcial esquerda, a curto prazo, no tratamento de pacientes com insuficiência cardíaca terminal. Métodos - De fevereiro a junho de 1995, 7 pacientes com insuficiência cardíaca terminal foram submetidos a ventriculectomia parcial esquerda. Antes do procedimento cirúrgico, os 7 (100%) pacientes apresentavam-se em grau funcional IV. Três (42%) pacientes faziam uso de inotrópicos para estabilização hemodinâmica. A dose média de furosemide era de 148,67 ± 128,17mg/dia, a de captopril 87,50 ± 95,20mg/dia e a de digoxina 0,23 ± 0,04mg/dia. A dimensão diastólica média do ventrículo esquerdo (VE), medida ecocardiograficamente, era de 78,29 ± 12,63mm, a fração de ejeção média do VE, determinada radioisotopicamente, era de 0,15 ± 0,05, enquanto que o gradiente transpulmonar e a resistência vascular pulmonar, em unidades Wood, estabelecidos por cateterismo, eram de 16,80 ± 8,80 e 6,57 ± 3,22, respectivamente. Resultados - Após 60 dias do procedimento cirúrgico, a classe funcional era, em média, 1,71 ± 0,48 (p= 0,009), a dimensão diastólica média do VE de 64,67 ± 11,41mm (p=0,02) e a fração de ejeção do VE 0,22 ± 0,04 (p=0,02).Conclusão - A ventriculectomia esquerda é um tratamento promissor para pacientes com insuficiência cardíaca termina