Outcome of non-transplant surgical strategy for end-stage dilated cardiomyopathy in young children.
BACKGROUND
The shortage of heart transplantation donors is a problem, but partial left ventriculectomy (PLV) and mitral valve replacement (MVR) are feasible at the optimal timing, even in young children.


RESULTS
From May 1998 to May 2008, 11 children under the age of 3 years were diagnosed with severe dilated cardiomyopathy (DCM). Indications and outcomes of non-transplant surgical strategies were evaluated and 8 procedures were performed in 6 children: 5 PLV and 3 MVR. Two of them underwent MVR after PLV because of deterioration of mitral regurgitation (MR). Age at surgery ranged from 8 months to 2 years 11 months. Four are alive, of whom 1 eventually underwent a heart transplant overseas. Two children died during the study period: 1 who underwent only MVR died of intracranial bleeding during thrombolytic therapy for a thrombus stack valve and the other child died of congestive heart failure because of progressive MR 2 months after PLV. Follow-up after PLV ranged from 2 months to 8 years, and after MVR ranged from 1 month to 4 years.


CONCLUSIONS
PLV and MVR are feasible and effective and should be considered when heart failure resists conventional therapy.
Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan. shisashi@hsp.ncvc.go.jp
Hisashi
H
Sugiyama
Minako
M
Hoshiai
Atsushi
A
Naitoh
Toshie
T
Kadono
Syoji
S
Suzuki
Kanji
K
Sugita
D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome