Partial left ventriculectomy (Batista's Procedure) case report: 40 months follow-up.
OBJECTIVE
Partial left ventriculectomy (PLV) (also known as Batista's Procedure) is a surgical procedure for treatment of dilated cardiomyopathy when cardiac transplant is contraindicated. Mitral valve replacement is needed because of mitral regurgitation as a consequence of annulus enlargement and papillary muscle resection. Bleeding and arrythmias are the main complications.


METHODS
We considered for this operation a 60-year-old male patient. He suffered from valvular dilating cardiomyopathy as a consequence of mitral and aortic valve regurgitation. Furthermore, a severe peripheral vascular disease treated with aortic-bifemoral prosthesis contraindicated heart transplantation. He needed frequent hospital admissions for pulmonary edema and his quality of life was very poor. Batista's procedure was performed in March 1998, successfully. Mitral and aortic valves were replaced by use of mechanical prosthesis. The postoperative period was characterized by early weaning from ventilator and drugs; atrial fibrillation, reversed by Amiodaron; a little bilateral pleural effusion; and pacemaker implantation following advanced heart conduction block. No bleeding episodes were observed. In March 2001 the progression of the vascular disease forced the patient to undergo to a femoro-femoral bypass and endoarterectomy of the right branch of the vascular prothesis. The patient tolerated the procedure very well. He had no complications during the postoperative period with early weaning from ventilator and drugs.


RESULTS
At the end of the procedure ejection fraction raised from 15% to 30%. Echocardiographic data demonstrated a slow but progressive improvement of the cardiac diameters and volumes with a preserved left ventricular function.


CONCLUSIONS
Even if a larger number of cases and longer follow-up are necessary, our report demonstrated that Batista's procedure should be considered as a surgical alternative to heart transplantation, in well-selected patients with absolute contraindication to heart transplantation and left ventricular assist device implantation.
Giuffrida
Angelo
A
Divisione di Cardiochirurgia, Ospedale Ferrarotto, Catania, Italy. giuftxct@tin.it
Leonardi
Giuseppe
G
Stimoli
Fortunato
F
Distefano
Tommaso
T
Sciacca
Sergio
S
Mudanò
Marco
M
Trimarchi
Eugenio
E
Abbate
Mauro
M
D006348:Cardiac Surgical Procedures / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011184:Postoperative Period; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000601:surgery*