Giuffrida Angelo, Leonardi Giuseppe, Stimoli Fortunato, Distefano Tommaso, Sciacca Sergio, Mudanò Marco, Trimarchi Eugenio, Abbate Mauro
Divisione di Cardiochirurgia, Ospedale Ferrarotto, Catania, Italy.
J Card Surg. 2003 May-Jun;18(3):197-200. doi: 10.1046/j.1540-8191.2003.02021.x.
Partial left ventriculectomy (PLV) (also known as Batista's Procedure) is a surgical procedure for treatment of dilated cardiomyopathy when cardiac transplant is contraindicated. Mitral valve replacement is needed because of mitral regurgitation as a consequence of annulus enlargement and papillary muscle resection. Bleeding and arrythmias are the main complications.
We considered for this operation a 60-year-old male patient. He suffered from valvular dilating cardiomyopathy as a consequence of mitral and aortic valve regurgitation. Furthermore, a severe peripheral vascular disease treated with aortic-bifemoral prosthesis contraindicated heart transplantation. He needed frequent hospital admissions for pulmonary edema and his quality of life was very poor. Batista's procedure was performed in March 1998, successfully. Mitral and aortic valves were replaced by use of mechanical prosthesis. The postoperative period was characterized by early weaning from ventilator and drugs; atrial fibrillation, reversed by Amiodaron; a little bilateral pleural effusion; and pacemaker implantation following advanced heart conduction block. No bleeding episodes were observed. In March 2001 the progression of the vascular disease forced the patient to undergo to a femoro-femoral bypass and endoarterectomy of the right branch of the vascular prothesis. The patient tolerated the procedure very well. He had no complications during the postoperative period with early weaning from ventilator and drugs.
At the end of the procedure ejection fraction raised from 15% to 30%. Echocardiographic data demonstrated a slow but progressive improvement of the cardiac diameters and volumes with a preserved left ventricular function.
Even if a larger number of cases and longer follow-up are necessary, our report demonstrated that Batista's procedure should be considered as a surgical alternative to heart transplantation, in well-selected patients with absolute contraindication to heart transplantation and left ventricular assist device implantation.
部分左心室切除术（PLV）（也称为巴蒂斯塔手术）是在心脏移植禁忌时用于治疗扩张型心肌病的一种外科手术。由于瓣环扩大和乳头肌切除导致二尖瓣反流，因此需要进行二尖瓣置换术。出血和心律失常是主要并发症。
我们为该手术考虑了一名60岁男性患者。他因二尖瓣和主动脉瓣反流患有瓣膜扩张型心肌病。此外，用主动脉-双股动脉假体治疗的严重外周血管疾病使心脏移植成为禁忌。他因肺水肿需要频繁住院，生活质量很差。1998年3月成功实施了巴蒂斯塔手术。使用机械假体置换了二尖瓣和主动脉瓣。术后早期成功撤机和停用药物；房颤经胺碘酮逆转；有少量双侧胸腔积液；在发生高度心脏传导阻滞后置入了起搏器。未观察到出血事件。2001年3月，血管疾病的进展迫使患者接受股-股旁路手术和血管假体右支的内膜切除术。患者对该手术耐受性良好。术后早期成功撤机和停用药物，未出现并发症。
手术结束时射血分数从15%提高到30%。超声心动图数据显示心脏直径和容积缓慢但逐渐改善，左心室功能得以保留。
即使需要更多病例和更长时间的随访，我们的报告表明，对于心脏移植和左心室辅助装置植入绝对禁忌的精心挑选的患者，巴蒂斯塔手术应被视为心脏移植的一种外科替代方案。
