IJCS | Volume 32, Nº6, November / December 2019

651 Table 1 - Pre-and postoperative echocardiographic data Postop Variable Preop 1 month 6 months 13 years LA (cm) 5.7 4.1 6.0 6.4 LVSD (cm) 6.9 4.9 5.9 6.8 LVDD (cm) 7.4 5.9 6.5 7.4 SV (ml) 42 60 43 40 RVD (cm) 3.5 2.7 3.3 3.7 LVEF (%) 14 35 20 17 PASP (mmHg) 50 37 65 59 LA: left atrium; LVSD: left ventricular systolic diameter; LVDD: left ventricular diastolic diameter; SV: systolic volume; RVD: right ventricular diameter; LVEF: left ventricular ejection fraction; PASP: pulmonary artery systolic pressure. Almeida Junior et al. Fourteen years’survival after batista operation Int J Cardiovasc Sci. 2019;32(6):650-654 Case Report Batista procedure, remains alive and has been considered a good non-transplant option for selected patients with end-stage DCM. Curiously, in relation to United States, the Batista procedure was not completely discontinued, considering that in the period of 2008-2014 it was applied in 401 patients but has been decreasing over time and is now employed in a limited number of selected patients. 5 Few cases of very long-term survival with PLV have been reported in the medical literature to date, in which patients were clinically well at the time of the publication and the longest reported survival is a 68-year-old woman who was alive 13 years after the operation that, coincidentally, was the first PLV applied in Korea. 6 Clinical case A 41-year-old man with a six-month history of progressive HF due to nonischemic DCM was hospitalized for clinical treatment, receiving bed rest, fluid restriction, diuretics, cardiac glycoside, ACE inhibitor (ACEI) (captopril), heparin and pentoxifylline, with transient improvement. He had no history of diabetes, hypertension, angina andmyocardial infarction. His coronary angiography was normal and serologic testing for Chagas disease, cytomegalovirus, hepatitis virus A, B, C, E and HIV infection all were negative. Despite treatment optimization, his clinical condition rapidly deteriorated and end-stage heart failure was diagnosed, necessitating inotropic therapy with dobutamine. The patient was listed for cardiac transplant. However, the heart of the problem was that, due to the shortage of organs and serious logistic difficulties at that time, the Batista surgery was offered as the last effort to save his life. An informed consent was obtained from the patient for the surgery. The procedure was carried out in August 1998. The operation was performed under normothermic standard cardiopulmonary bypass and the technique used was based on that originally described by Batista and colleagues. 3 In simple terms, the procedure consisted of resection of a large slice of the posterolateral LV wall, beginning from the apex to near the mitral annulus, preserving the papillary muscles and subsequent ventriculorraphy. It is interesting to note that right ventriculectomy was also performed at the same time, because of the large right ventricular dilatation. Concomitantmitral and tricuspid repairswere performed. The postoperative course was uneventful. Pre-and postoperative transthoracic echocardiography data are summarized in Table 1. One month after the operation, the echocardiographic examination showed significant improvement: the left atrial and ventricular sizes aswell as right ventricular dimensionswere reduced, LV ejection fraction increased, while pulmonary arterial systolic pressure declined. Trivial tricuspid and mitral regurgitation remained after surgery. The patient achieved NYHA class-II, remaining under optimized medication with furosemide, ACEI, spironolactone, B-blocker (carvedilol) and digoxin. The nutrition was improved, and the patient gradually recovered his normal weight. Although at six months after the procedure the heart chambers were redilated, the patient still continued to maintain good clinical condition. Thirteen years after the operation the transthoracic echocardiogram and the cardiac MRI showed enlargement of the heart chambers, atrioventricular valve regurgitation and severe ventricular systolic dysfunction (Figures 1-A, 1-B, 2-A and 2-B). The clinical condition deteriorated only in the last year of his life, after the development of persistent atrial fibrillation, requiring several hospitalizations. Discussion Despite modern treatment of patients with advanced DCM, the morbi-mortality rates continue to be high and