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CLINICAL STUDIES

Effects of partial left ventriculectomy on left ventricular performance in patients with nonischemic dilated cardiomyopathy

Zoran Popovi, MD^a, Milutin Miri, MD, PhD^a, Sinia Gradinac, MD^a, Aleksandar N. Nekovi, MD^a, Ljiljana Jovovi, MD, PhD^a, Ljiljana Vuk, MD^a, Milovan Boji, MD, PhD^a and Aleksandar D. Popovi, MD, PhD, FESC, FACC^a

^a Dedinje Cardiovascular Institute and Belgrade University Medical School, Belgrade, Yugoslavia

Manuscript received March 9, 1998; revised manuscript received June 6, 1998, accepted August 6, 1998.

Address for correspondence: Dr. Aleksandar D. Popovi, Dedinje Cardiovascular Institute, Milana Tepia 1, 11040 Belgrade, Yugoslavia
epopoval{at}ubbg.etf.bg.ac.yu

Objectives. This study sought to assess the effects of partial left ventriculectomy (PLV) on left ventricular (LV) performance in a series of consecutive patients with nonischemic dilated cardiomyopathy.

Background. Reduction of LV systolic function in patients with heart failure is associated with an increase of LV volume and alteration of its shape. Recently, PLV, a novel surgical procedure, was proposed as a treatment option to alter this process in patients with dilated cardiomyopathy.

Methods. We studied 19 patients with severely symptomatic nonischemic dilated cardiomyopathy, before and 13 ± 3 days after surgery, and 12 controls. Single-plane left ventriculography with simultaneous measurements of femoral artery pressure was performed during right heart pacing.

Results. The LV end-diastolic and end-systolic volume indexes decreased after PLV (from 169 to 102 ml/m², and from 127 to 60 ml/m², respectively, p < 0.0001 for both). Despite a decrease in LV mass index (from 162 to 137 g/m², p < 0.0001), there was a significant decrease in LV circumferential end-systolic and end-diastolic stresses (from 277 to 159 g/cm², p < 0.0001 and from 79 to 39 g/cm², p = 0.0014, respectively). Ejection fraction improved (from 24% to 41%, p < 0.0001); the stroke work index remained unchanged.

Conclusions. The PLV improves LV performance by a dramatic reduction of ventricular end-systolic and end-diastolic stresses. Further studies are needed to assess whether this effect is sustained during long-term follow-up and to define the role of PLV in the treatment of patients with dilated cardiomyopathy.

Abbreviations and Acronyms   LV = left ventricle   LVEF = left ventricular ejection fraction   LVSWI = left ventricular stroke work index   PLV = partial left ventriculectomy

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