Suma H, Isomura T, Horii T, Ichihara T, Sato T, Fujisaki H, Nishimi M, Ukawa T, Iwahashi K, Saito S, Hosokawa J
Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kanagawa.
J Cardiol. 1998 Feb;31(2):83-90.
The Batista operation is intended to improve cardiac function by reducing the diameter of the left ventricle by excising of a sizable amount of the left ventricular free wall. Candidates for this operation are patients awaiting cardiac transplantation due to end-stage dilated cardiomyopathy and those unsuitable for transplantation because of age, physical or economical reasons. We performed this operation in 10 patients between December 1996 and October 1997. The baseline indication is left ventricular diastolic dimension > or = 70 mm and New York Heart Association (NYHA) class III or IV. There were eight men and two women aged from 16 to 60 years (mean 46 years). All had non-ischemic cardiomyopathy including seven idiopathic and one each of hypertrophic, arrhythmogenic right ventricular and valvular (sarcoidosis) cardiomyopathy. Eight patients were in NYHA class IV and six needed inotropic drip therapy prior to the operation. Nine patients had significant mitral regurgitation and six had tricuspid insufficiency concomitantly. Eight patients underwent mitral valve replacement and one was treated with mitral valve plasty. Six patients also had tricuspid plasty combined with partial left ventriculectomy. Eight patients survived. Mean value of left ventricular end-diastolic diameter was reduced from 77.8 mm to 59.8 mm, left ventricular end-diastolic volume index was reduced from 189.3 to 99.2 ml/m2, ejection fraction was increased from 19.0% to 33.8% and NYHA class improved from 3.8 to 1.8. Six months later, left ventricular dilatation was not noticed in four patients examined. The Batista operation offers real hope for patients with end-stage dilated cardiomyopathy, but we still have much to learn.
巴蒂斯塔手术旨在通过切除相当一部分左心室游离壁来缩小左心室直径，从而改善心脏功能。该手术的候选者包括因终末期扩张型心肌病而等待心脏移植的患者，以及因年龄、身体或经济原因而不适合移植的患者。我们在1996年12月至1997年10月期间对10例患者实施了该手术。基线指征为左心室舒张末期直径≥70mm且纽约心脏协会（NYHA）心功能分级为Ⅲ级或Ⅳ级。患者中有8名男性和2名女性，年龄在16至60岁之间（平均46岁）。所有患者均患有非缺血性心肌病，其中包括7例特发性心肌病，1例肥厚型心肌病、致心律失常性右心室心肌病和瓣膜性（结节病）心肌病各1例。8例患者NYHA心功能分级为Ⅳ级，6例患者在手术前需要进行正性肌力药物静脉滴注治疗。9例患者伴有严重二尖瓣反流，6例患者同时伴有三尖瓣关闭不全。8例患者接受了二尖瓣置换术，1例患者接受了二尖瓣成形术。6例患者还接受了三尖瓣成形术并联合部分左心室切除术。8例患者存活。左心室舒张末期直径的平均值从77.8mm降至59.8mm，左心室舒张末期容积指数从189.3降至99.2ml/m²，射血分数从19.0%提高到33.8%，NYHA心功能分级从3.8改善至1.8。6个月后，在接受检查的4例患者中未发现左心室扩张。巴蒂斯塔手术为终末期扩张型心肌病患者带来了真正的希望，但我们仍有许多需要学习的地方。
