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

Abstract

Case Report ABSTRACTMorbid 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/m 2 and 37 kg/m 2 , respectively. They underwent a sleeve gastrectomy and reached a BMI of 28 kg/m 2 , 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.In conclusion, bariatric surgery offers a significant benefit for obese patients with DCM and should be considered by cardiologists as other therapeutic approach when other weight loss strategies had failed. CASE REPORTSCase 1: A 54-year-old male with Sleep Apnea Syndrome (SAS), Diabetes Mellitus (DM) type 2, hypertension, Morbid Obesity (MO) and Dilated cardiomyopathy (DCM) was referred to our hospital for bariatric surgery. In addition, the preoperative cardiac ultrasound showed a Ventricular Ejection Fraction (VEF) of 24%. He had a Body Mass Index (BMI) of 41 kg/m 2 and underwent an uneventful Sleeve Gastrectomy (SG). Three years after the surgical procedure, the patient co-morbidities and quality of life have improved, and the cardiac ultrasound confirmed an increase of his VEF from 24% to 36% ( Figure 1A-1B).