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Effects of partial left ventriculectomy on left ventricular performance in patients with nonischemic dilated
Z Popović1, M Mirić, S Gradinac
1Dedinje Cardiovascular Institute and Belgrade University Medical School, Yugoslavia.
Insights
Partial left ventriculectomy (PLV) significantly improves left ventricular (LV) performance in patients with dilated cardiomyopathy. This surgical procedure reduces LV stress and enhances ejection fraction, offering a promising treatment option.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Research
Background:
- Heart failure in dilated cardiomyopathy is linked to increased LV volume and altered shape, reducing systolic function.
- Partial left ventriculectomy (PLV) is a novel surgical approach designed to address these detrimental changes.
Purpose of the Study:
- To evaluate the impact of PLV on left ventricular (LV) performance in patients with nonischemic dilated cardiomyopathy.
- To assess changes in LV dimensions, stress, and ejection fraction following PLV.
Main Methods:
- Studied 19 patients with severe nonischemic dilated cardiomyopathy before and after PLV (13±3 days).
- Included a control group of 12 patients.
- Utilized single-plane left ventriculography and femoral artery pressure measurements during right heart pacing.
Main Results:
- PLV significantly reduced LV end-diastolic and end-systolic volumes (169 to 102 ml/m², 127 to 60 ml/m²).
- LV mass index decreased (162 to 137 g/m²), alongside a significant reduction in LV circumferential end-systolic and end-diastolic stresses.
- Ejection fraction improved markedly (24% to 41%), while stroke work index remained unchanged.
Conclusions:
- PLV enhances LV performance by substantially decreasing ventricular end-systolic and end-diastolic stresses.
- Further research is necessary to confirm long-term efficacy and establish PLV's definitive role in treating dilated cardiomyopathy.
Objectives:
This study sought to assess the effects of partial left ventriculectomy (PLV) on left ventricular (LV) performance in a series of consecutive patients with nonischemic dilated cardiomyopathy.
Background:
Reduction of LV systolic function in patients with heart failure is associated with an increase of LV volume and alteration of its shape. Recently, PLV, a novel surgical procedure, was proposed as a treatment option to alter this process in patients with dilated cardiomyopathy.
Methods:
We studied 19 patients with severely symptomatic nonischemic dilated cardiomyopathy, before and 13+/-3 days after surgery, and 12 controls. Single-plane left ventriculography with simultaneous measurements of femoral artery pressure was performed during right heart pacing.
Results:
The LV end-diastolic and end-systolic volume indexes decreased after PLV (from 169 to 102 ml/m2, and from 127 to 60 ml/m2, respectively, p < 0.0001 for both). Despite a decrease in LV mass index (from 162 to 137 g/m2, p < 0.0001), there was a significant decrease in LV circumferential end-systolic and end-diastolic stresses (from 277 to 159 g/cm2, p < 0.0001 and from 79 to 39 g/cm2, p = 0.0014, respectively). Ejection fraction improved (from 24% to 41%, p < 0.0001); the stroke work index remained unchanged.
Conclusions:
The PLV improves LV performance by a dramatic reduction of ventricular end-systolic and end-diastolic stresses. Further studies are needed to assess whether this effect is sustained during long-term follow-up and to define the role of PLV in the treatment of patients with dilated cardiomyopathy.