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From the Hospital Angelina Caron, Campina Grande do Sul, Brazil
(R.J.V.B.); and the Divisions of Cardiology (J.G., A.M.F.), Pathology
(A.J.D.), and Cardiothoracic Surgery (R.L.K., W.A.M.), University of
Pittsburgh, Pittsburgh, Pa.
Correspondence to John Gorcsan III, MD, University of Pittsburgh, Department of Cardiology, Scaife Hall Fifth Floor, 200 Lothrop St, Pittsburgh, PA 15213. E-mail gorcsan{at}a1.isd.upmc.edu
Background—Partial left
ventriculectomy (PLV) is a novel surgical treatment for severe heart
failure consisting of resection of a large wedge of
myocardium to reduce wall stress and restore the normal
mass-volume ratio. Although ejection fraction (EF) has been shown to
improve after PLV, few other physiological data
describing its immediate effects on left ventricular (LV)
performance are available.
Methods and Results—Eight patients, 58±5 years old, with severe
clinical heart failure and EF of 12±3% were studied before and
immediately after PLV. LV performance was assessed by the
predominantly load-insensitive measures of pressure-area relations with
high-fidelity pressure catheters and transesophageal
automated echocardiographic measures of cross-sectional
area as a surrogate for volume. LV end-diastolic volume
decreased from 200±60 to 89±17 mL, EF increased from 12±3% to
41±8%, and right ventricular (RV) fractional area change
increased from 24±12% to 37±16% (all P<.05 versus
before). Changes in pressure-area relations were variable:
end-systolic elastance, 6.5±3.4 to 4.3±2.5
mm Hg/cm2 and preload recruitable stroke work, 33±16 to
34±19 mm Hg (P=NS versus before).
End-diastolic stiffness increased from 0.13±0.06 to
0.19±0.07 mm Hg/cm2 (P<.05 versus
before). Improvement in LV performance was inversely correlated
with semiquantitative histological assessment of
myocardial fibrosis and positively correlated with nuclear enlargement
and hyperchromasia, indicative of myocyte hypertrophy. No
long-term follow-up data were available.
Conclusions—PLV resulted in reductions in LV volumes, increases
in EF and RV ejection, but increases in LV stiffness. Estimates of LV
performance revealed variable results associated with the
degree of myocardial fibrosis. Further study of these effects in
relation to patient outcome is warranted.
© 1998 American Heart Association, Inc.
Brief Rapid Communications
Heterogeneous Immediate Effects of Partial Left Ventriculectomy on Cardiac Performance
Key Words: ventricles • surgery • heart failure
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