title: Sublocalization of Cardiac Involvement in Sarcoidosis and Surgical Exclusion in Patients With Congestive Heart Failure.
abstract: BACKGROUND
  In sarcoidosis, cardiac involvement can cause fatal conditions such as left ventricular (LV) dysfunction and rhythm disturbance. We surgically treated critical patients with congestive heart failure due to cardiac sarcoidosis.
  
  
  METHODS
  During 14 years, 384 patients with nonischemic dilated cardiomyopathy were operated. Among them, 14 patients (3.6%) with New York Heart Association (NYHA) class IV (male/female, 3/11; 57 ± 11 years) caused by sarcoidosis underwent surgery (elective/emergent, 12/2). The akinetic lesion, as identified by speckle-tracking echocardiography, was excluded.
  
  
  RESULTS
  Localization of akinetic lesions was achieved in 13 patients (93%). In the short axis, lesional distribution was higher in the anterior (62%) and septal segments (54%) when compared with the posterior (31%) and lateral segments (23%). Along the long axis, regional distribution was higher in the mid (85%) and apical segments (69%) when compared with the basal segment (31%). The main lesions were excluded by septal anterior ventricular exclusion (n = 5), posterior restoration procedure (n = 3), endoventricular circular patch plasty (n = 3), and linear resection (n = 2). Mitral valve surgery included mitral valve plasty (n = 7) and replacement (n = 7). In patients undergoing elective surgery, early results showed that 10 patients survived (83%) and NYHA class improved (6 patients in class II and 4 in class III). Patients who underwent emergent surgery did not survive. The observation period was 55 ± 59 months in survivors. During follow-up, 4 patients died after 42 ± 48 months. The other 5 patients have survived for 71 ± 61 months. The 3- and 5-year survival rates were 65% and 52%, respectively.
  
  
  CONCLUSIONS
  Sarcoidosis can result in sublocalized LV involvement, which can be surgically excluded.
authors.affiliation: Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan. Electronic address: hirota@hayamaheart.gr.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Hirota
authors.affiliation: Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Hoshino
authors.affiliation: Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Isomura
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D009202:Cardiomyopathies / Q000150:complications* / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications* / Q000473:pathology