Partial left ventriculectomy in pediatric end-stage dilated cardiomyopathy.
OBJECTIVE
Although a recent survey on pediatric cardiomyopathy in Japan showed that 48% of patients died despite the medical treatment, pediatric cardiac transplantation is not legal in Japan. We determined the feasibility of partial left ventriculectomy as an alternative to end-stage dilated cardiomyopathy.


METHODS
We retrospective analyzed partial left ventriculectomy in 4 pediatric patients with end-stage dilated cardiomyopathy.


RESULTS
In case 1, an 8-month-old girl underwent semiemergency partial left ventriculectomy. Her ejection fraction increased from 10% to 25%, and her condition improved initially, but she developed heart failure and underwent cardiac transplantation 6 months later in the US. In case 2, a 3-year-old boy developed severe heart failure 2 months after ventricular septal defect repair. Intensive medical therapy failed, so partial left ventriculectomy was done, which increased his ejection fraction from 15% to 35%. His condition is stable 35 months after surgery. In case 3, a 2-year-old girl with a chromosomal anomaly undergoing ventricular septal defect repair developed progressive heart failure 1 year later. Despite emergency partial left ventriculectomy, she died of hemoptysis 2 weeks postoperatively. In case 4, a 2-year-old girl developing progressive heart failure unresponsive to medical therapy after 10 months underwent elective partial left ventriculectomy and remains in stable condition 18 months postoperatively.


CONCLUSIONS
Partial left ventriculectomy is appropriate for selected patients with end-stage dilated cardiomyopathy if medical therapy is not effective and heart transplantation is not possible.
Yoshii
Shinpei
S
Department of Surgery, Yamanashi Medical University, Tamaho-cho, Nakakoma-gun, Yamanashi 409-3898, Japan.
Suzuki
Shoji
S
Hosaka
Shigeru
S
Osawa
Hiroshi
H
Takahashi
Wataru
W
Abraham
Samuel J K
SJ
Tada
Yusuke
Y
Sugiyama
Hisashi
H
Tan
Tetsushi
T
Kanazawa
Hiroshi
H
D006348:Cardiac Surgical Procedures / Q000379:methods; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male