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Objective: To assess the efficacy of partial left ventriculectomy as a treatment for patients with end-stage heart failure., Methods: From February to June 1995, 7 patients with end-stage heart failure underwent partial left ventriculectomy. Subsequently, patients underwent clinical evaluation every 2 months, and 2-dimensional echocardiography at the 6th and 12th months after cardiac surgery. All patients were given digitalis and diuretics at conventional doses, and captopril or enalapril at maximal tolerated doses., Results: Two (28%) patients died; 1 from cardiac arrhythmia associated with gastrointestinal hemorrhage, and the other suddenly. One (14%) patient developed an embolic cerebrovascular accident. Four (57%) patients were hospitalized for congestive heart failure; all of them had either decreased the daily dose of captopril or enalapril or discontinued the drugs by themselves. Twelve months after ventriculectomy, left ventricular ejection fraction values were greater and left ventricular diastolic dimension and functional class values lower than those found before cardiac operation., Conclusion: Beneficial effects of partial left ventriculectomy are observed one year after the surgical procedure. This technique, therefore, can be useful for the treatment of patients with end-stage heart failure.

The aim of this study was to assess the peripheral and cardiac autonomic system by catecholamine measurements in patients with severe chagasic and nonchagasic heart failure. Fifteen chagasic and 16 nonchagasic patients were enrolled in the study. Plasma venous norepinephrine levels (pg/ml) were 397.26 +/- 250.11 for chagasic and 660.05 +/- 455.57 for nonchagasic patients (p > 0.05), plasma venous epinephrine levels 215.84 +/- 254.04 for chagasic and 106.17 +/- 65.90 for nonchagasic patients (p > 0.05), aortic root norepinephrine levels 435.46 +/- 306.60 for chagasic and 668.16 +/- 512.82 for nonchagasic patients (p > 0.05), aortic root epinephrine levels 300.33 +/- 302.69 for chagasic and 199.98 +/- 162.88 for nonchagasic patients (p > 0.05), coronary sinus norepinephrine levels 636.10 +/- 495.22 for chagasic and 552.17 +/- 535.54 for nonchagasic patients (p > 0.05) and coronary sinus epinephrine levels 226.66 +/- 277.47 for chagasic and 69.21 +/- 35.62 for nonchagasic patients (p = 0.02). Myocardial and peripheral norepinephrine and epinephrine extractions were similar for both groups. Taken together, these findings may suggest that chagasic patients with congestive heart failure have biochemical evidence of cardiac autonomic dysfunction with preservation of the peripheral sympathetic activity.