左心室部分切除术治疗晚期原发性扩张性心肌病五例报告

Partial left ventriculectomy for the treatment of end stage dilated cardiomyopathy

目的 总结左心室部分切除术 (PLV)治疗 5例晚期原发性扩张性心肌病的初步经验。方法 1998年 4月至 8月 ,对 5例原发性扩张性心肌病病人接受PLV治疗 ,年龄 4 2～ 5 3岁 ,术前心功能III级 3例、IV级 2例 ,均有二尖瓣关闭不全 ,其中 1例同时合并三尖瓣重度关闭不全。在体外循环 ,冷血灌注 ,心脏停搏下手术。切除左心室心肌重量 4 1 3～ 5 3g。均同时行二尖瓣环缩术 ,1例行三尖瓣环缩术。结果 术后超声心动检查 :左心室内径显著减少 [( 8 4± 1 1)cm到 ( 5 5± 0 4 )cm ,P <0 0 1],射血分数显著增加 [( 17 8±6 3 ) %到 ( 3 4 8± 3 2 ) % ,P <0 0 2 5 ]。 1例病人术后第 6天死于左心衰竭 ,长期存活的 4例随访时间 3～ 6月。心功能恢复到II级的 3例 ,I级的 1例。结论 PLV是治疗晚期原发性扩张性心肌病的新的手术方法 ,初步结果良好 ,远期效果有待进一步观察。

Objective To report our experience of the first 5 cases of Partial left ventriculectomy (PLV or Batista operation), a new surgical therapy for end stage dilated cardiomyopathy in China Methods From April to August 1998, 5 patients with idiopathic dilated cardiomyopathy received PLV at Anzhen hospital The age of the patients ranged from 42 to 53 years, 3 patients were in NYHA class III and 2 in class IV All patients had mitral valve insufficiency (3 moderate and 2 severe) and 1 had severe tricuspid valve insufficiency preoperatively Cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia were used in all patients The weight of the resected left ventricle muscle was 41 3～53 0 mg All patients underwent mitral annuloplasty and 1 plus a tricuspid annuloplasty (De Vega) Results End cardiography demonstrated a significant decrease in the left ventricular diastolic diameter (8 4±1 1) cm to( 5 5±0 4 ) cm, P <0 01 and an increase in ejection fraction (17 8±6 3)% to (34 8±3 2)% P <0 025 One patient died of heart failure on 6th day after operation The mean follow up period of the 4 discharged patients were 4 months (from 3 to 6 months), 1 was in NYHA class I and 3 in class II Conclusion Batista operation is a new and valuable alternative for the surgical treatment of end stage dilated cardiomyopathy. Its long term result need further studies