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Ann Thorac Surg 1999;67:1542
© 1999 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Heart Institute of São Paulo University, Av Dr. Enéas Carvalho Aguiar, 44, São Paulo, SP, Brazil 05403-000

e-mail: dcimoreira{at}incor.usp.br

To the Editor

We agree with Dr Cui that the exact role of partial left ventriculectomy in the hemodynamic improvement of patients with dilated cardiomyopathy is still unknown. On the other hand, the early and midterm positive influence of this surgical procedure on left ventricular ejection fraction, geometry, and wall motion has been widely demonstrated by several authors [1–4]. Also, the high incidence of heart failure progression and arrhythmia-related deaths in the partial left ventriculectomy early postoperative period precludes its wide clinical application and indicates the necessity to identify preoperative and surgical factors associated with the unfavorable outcome, as discussed by our cited publication [4].

Regarding the right ventricular function, Bocchi and associates [5] documented the significant improvement of the radioisotopic right ventricular ejection fraction (from 20.5 ± 6.2% to 27.9 ± 8.4%, p = 0.02), concomitantly with the left ventricular function modifications. Also important is the fact that the increase of left ventricular ejection fraction occurred in our patients by the global improvement of ventricular wall motions, including the interventricular septal movement, as suggested by Dr Cui’s letter. Additional studies are needed, however, to determine the exact influence of interventricular septum and right ventricular function modifications on left ventricular performance after the surgical volume reduction.

References

1. Bellotti G., Moraes A., Bocchi E.A., et al. Effects of partial ventriculectomy on left ventricular mechanical properties, shape and geometry in patients with dilated cardiomyopathy. Arq Bras Cardiol 1996;67:395-400.[Medline]
2. McCarthy J.F., McCarthy P.M., Starling R.C., et al. Partial left ventriculectomy and mitral valve repair for end-stage congestive heart failure. Eur J Cardio-Thorac Surg 1998;13:337-343.[Abstract/Free Full Text]
3. Gradinac S., Miric M., Popovic Ad, et al. Partial left ventriculectomy for idiopathic dilated cardiomyopathy: early results and six-month follow-up. Ann Thorac Surg 1998;66:1963-1968.[Abstract/Free Full Text]
4. Stolf N.A.G., Moreira L.F.P., Bocchi E.A., et al. Determinants of midterm outcome of partial left ventriculectomy in dilated cardiomyopathy. Ann Thorac Surg 1998;66:1585-1591.[Abstract/Free Full Text]
5. Bocchi E.A., Bellotti G., Moraes A.V., et al. Clinical outcome after left ventricular surgical remodeling in patients with idiopathic dilated cardiomyopathy referred for heart transplantation. Circulation 1997;96(suppl. II):165-172.

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