title: Myocardial fiber diameter as a good indicator of outcome in Batista's operation.
abstract: BACKGROUND
  Despite the initial promissory results of partial left ventriculectomy, or Batista's operation, the postoperative mortality associated with the procedure has been too high. We described a histopathologic study performed to identify histological parameters that could help to determine outcomes of patients undergoing this procedure.
  
  
  RESULTS
  Myocardial fiber diameter, myocardial fibrosis, thickness of the compact wall, and number of cells presenting from the endocardium to epicardium were analyzed in 32 patients with idiopathic dilated cardiomyopathy who underwent Batista's operation. Data were grouped by patients who died < or = 6 months and patients who survived for > 6 months after the surgical procedure. Additional analyses were performed to compare results according the causes of death and to test the application of these results to biopsy.
  
  
  RESULTS
  Myocardial fiber diameter was the only index that could distinguish the two groups. Myocardial fiber diameter < 22 microm distinguished the group of patients who survived the 6-month postoperative period from patients who died during that time with sensitivity of 85.7 and specificity of 72.2. The subendocardial region of the compact wall and the trabecular portion of the wall exhibited comparable results.
  
  
  CONCLUSIONS
  Our results indicate that the myocardial fiber diameter of samples from the trabecular or subendocardial compact wall regions may help predict the outcome of left ventriculectomy. Samples from the trabecular or subendocardial compact wall regions were used for analysis. Further prospective studies involving left ventricular endomyocardial biopsies are necessary to confirm if the use of myocardial fiber diameter in the selection of patients for surgery improves the index of success of Batista's operation. Other factors that are involved remain unclear.
authors.affiliation: Service of Pathology, Heart Institute (InCor), University of São Paulo Medical School, SP, Brazil. anplourdes@incor.usp.br
authors.forename: M L
authors.initials: ML
authors.lastname: Higuchi
authors.forename: L F
authors.initials: LF
authors.lastname: Moreira
authors.forename: J M
authors.initials: JM
authors.lastname: Silvestre
authors.forename: P S
authors.initials: PS
authors.lastname: Gutierrez
authors.forename: C
authors.initials: C
authors.lastname: Savalli
authors.forename: N
authors.initials: N
authors.lastname: Stolf
authors.forename: G
authors.initials: G
authors.lastname: Bellotti
authors.forename: J A
authors.initials: JA
authors.lastname: Ramires
authors.forename: A
authors.initials: A
authors.lastname: Jatene
mesh_terms: D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D004699:Endocardium / Q000473:pathology; D005260:Female; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome