Obesity Research · Vol. 1, No. 1 · 2014 · pp. 1–3 · e-ISSN 2377-8385

Improvement of Ventricular Ejection Fraction after Bariatric Surgery in Obese Patients with Dilated Cardiomyopathy

Jorge de Tomás, , Alejandro Lusilla, Mauricio Burneo, Rocio Franco, Jose Maria-Monturiol

DOI: https://doi.org/10.17140/oroj-1-101 · Published 2014-12-04 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2014 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Abstract

Morbid obesity has been considered a contraindication for cardiac transplantation in some patients with Dilated cardiomyopathy (DCM). However, the positive effect of bariatric surgery on this population, with improvement in Ventricular Ejection Fraction (VEF), could even avoid the necessity of a cardiac transplant. Obesity produces cardiac dysfunction and weight loss operations can partially revert it. The impact of bariatric surgery among people with DCM has been studied in two patients with morbid obesity. Both male patients suffered from DCM with a VEF less than 27%, and other co-morbidities. Their Body Mass Index (BMI) was 44 kg/m2 and 37 kg/m2 , respectively. They underwent a sleeve gastrectomy and reached a BMI of 28 kg/m2 , 18 months after the operation, with more than 10% improvement in their VEF. The second patient had a gastric leak, due a stapler failure, and finally underwent an uneventful total gastrectomy after unsuccessful endoscopic procedures.

Keywords: Dilated cardiomyopathy (DCM); Ventricular Ejection Fraction (VEF); Bariatric surgery; Morbid Obesity (MO); Dilated cardiomyopathy (DCM); Ventricular Ejection Fraction (VEF); Bariatric surgery; Morbid Obesity (MO)

Discussion

failed and the patient developed a leak near the esophagogastric

Obesity causes anatomical and functional heart impairjunction, albeit a prompt reoperation was done during the first

ment, which can be ameliorated with weight loss surgery, as an 48 hours. All the subsequent therapeutic approaches with stents, 1-3 increase in cardiac output, preload and post-load.1-3 In patients glues or metallic clips were unsuccessful (Figure 2) and finally,

with DCM, these hemodynamic changes produce impairment in a total gastrectomy was performed, with an excellent recovery.

the systolic left ventricular function and a larger heart dilatation. 18 months after the first bariatric procedure, the patient showed

In the recent literature there is some evidence about the posian improvement of 10% in his VEF as well as in his co-morbid- 3-6 tive impact of BS on specific cases of heart disease as DCM.3-6 ities.

Furthermore, some patients with DCM who are in an end-stage

heart failure have been denied cardiac transplantation due to

MO. Nevertheless, it has been shown that the cardiac function

improvement after different bariatric procedures can avoid the

4-6 necessity of an ulterior cardiac transplantation.4-6

On the other hand, those patients usually have other co-

morbidities linked to the metabolic syndrome (SAS, DM, hyper-

tension) that improve after weight loss.

Which bariatric technique is the best for such patients?

This is a difficult question but the simplest is the best in

this scenario. For this reason, we preferred sleeve gastrectomy

instead of gastric bypass. However, we had a dreadful complica-

tion in our second case due to a technical problem but, at the end,

the gastric leak was solved and the patient was able to experi-

ment the benefits of a significant loss of his weight.

If we focus on functional heart changes, VEF increase

is perhaps one of the most relevant indicators, and it has been

4,6

Figure 2
Figure 2. Barium swallow of case 2 patient after failure to control the gastric leak (V) by a highlighted in other cases.4,6 Nowadays, is appropriate to con- metallic clip (arrow).

firm the durability of this benefit and how is the long-term heart

behaviour of these patients with larger prospective studies.

In summary, BS offers an important improvement in

obese patients with DCM. Thus, it should be consider when oth-

er weight loss approaches were unsuccessful because bariatric

operations are quite safe and effective at the present time.

References

  1. LuacesMCachofeiroVGarcía-Muñoz-NajarA. Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery. Rev Esp Cardiol. 2012; 65(1): 14-21. doi: 10.1016/j.recesp.2011.06.01810.1016/j.recesp.2011.06.018 https://doi.org/10.1016/j.recesp.2011.06.018
  2. GarzaCAPellikkaPASomersVK. Structural and functional changes in left and right ventricles after major weight loss following bariatric surgery for morbid obesity. Am J Cardiol. 2010; 105(4): 550-556. doi: 10.1016/j.amjcard.2009.09.05710.1016/j.amjcard.2009.09.057 https://doi.org/10.1016/j.amjcard.2009.09.057
  3. González-Mansilla A, de Tomás J, Yotti R, Álvarez-Llano L. Cardiac functional and structural improvement after vertical gastrectomy in an obese patient with noncompactation cardiomyopathy. Med Clin (Barc). 2014; 143(8): 377-378. doi: 10.1016/j. medcli.2014.01.005 https://doi.org/10.1016/j.medcli.2014.01.005
  4. RistowBRabkinJHaeussieinE. Improvement in dilated cardiomyopathy after bariatric surgery. J Card Fail. 2008; 14(3): 198-202. doi: 10.1016/j.cardfail.2007.12.00610.1016/j.cardfail.2007.12.006 https://doi.org/10.1016/j.cardfail.2007.12.006
  5. SamarasKConnollySMLordRVMacdonaldPHaywardCS. Take heart: bariatric surgery in obese patients with severe heart failure. Two cases reports. Heart Lung Circ. 2012; 21(12): 847-849. doi: 10.1016/j.hlc.2012.05.78310.1016/j.hlc.2012.05.783 https://doi.org/10.1016/j.hlc.2012.05.783
  6. McCloskeyCARamaniGVMathierMA. Bariatric surgery improves cardiac function in morbidily obese patients with severe cardiomyopathy. Surg Obes Relat Dis. 2007; 3(5): 503- 507. doi: http://dx.doi.org/10.1016/j.soard.2007.05.00610.1016/j.soard.2007.05.006 https://doi.org/10.1016/j.soard.2007.05.006