"You Say I Live in the Jungle"

A few quotes from:

Randas J.V. Batista, M.D.

"When I was a little boy my grandmother wrote the word "WHY" backwards on a piece of adhesive tape and pasted it to my forehead. She told me to look at myself in the mirror. Her lesson was that I should always ask myself that question. That was her gift to me"

"Those who ask the questions are condemned to find the answers."

"The ratios between the mass and diameter of all the hearts in nature are the same, from snakes to buffaloes. When the ratio becomes too small, heart failure occurs."

"If I had stayed in this country (the United States), I wouldn’t have come up with this procedure, because I wouldn’t have had the need for it."

"I don’t come as the owner of truth. I come with different ideas to share and learn. If you prove me wrong, I will be happy, because then I’ll be the one who learns, not you!"

"The way we follow our patients post-operatively (in Curitiba, Brazil) is to check if they have warm, pink feet, good urinary output, and that there is no blood in the surgical drain."

"The enlarged heart spends a lot of energy but does very little work: it doesn’t contract well and it doesn’t move blood effectively."

Doctor Batista says that his background was in physics. "He who has a hammer in his hand -- all the problems he sees will be nails."

Quoting Albert Einstein, Doctor Batista notes, "Something is impossible until someone doubts and shows the other way around."

In answer to a question about whether this technique was based on La Place’s law, Batista said, "La Place’s law that states that decreasing wall tension by decreasing the diameter of the ventricle is only one factor. Different pathologies (for example different precipitating causes of dilated cardiomyopathy) will have different results. For example, valvular cardiomyopathy is much more responsive to cardiomyoplasty than Chagas’ disease. All that reducing the diameter does is to decrease the work load (on the heart muscle); it doesn’t change the basic pathology."

"Energy consumption by the myocardium decreases, while stroke work, stroke volume, ejection fraction, and cardiac output all increase after reduction cardiomyoplasty."

When asked what else interested him, Doctor Batista replied: "Eisenmenger’s syndrome in children. Pulmonary hypertension is caused by oxygenated hyperflow; you want to avoid excessive oxygen in the pulmonary arterial circulation. This is accomplished by banding the pulmonary arteries for two years being careful not to allow arterial oxygen saturation to rise above 60 mmHg. This keeps the right atrial blood very desaturated and reduces oxygen toxicity to the pulmonary arteries. The pulmonary artery is debanded after two years and the ventricular septal defect is closed."

"I live at the edge of the Brazilian jungle. I don’t have a lot of equipment, but I treat my patients in the best way I can. In New York, doctors (with very high-tech equipment) are afraid to operate on their sickest patients because they are afraid of being sued if they have a bad outcome."

"In 1994, physicians at Yale University recommended not operating on patients with ejection fractions of less than 20%. I like to operate on those patients; I can do the most for them. You say I live in the jungle, and I look at New York and I ask myself which place is the jungle."