here is an expression in Brazil--dar um jeito--that, loosely translated, means no problem is unsolvable and no barrier too great to cross. Dr. Randas Jose Vilela Batista adopted this attitude in dealing with the patients in his tiny rural hospital outside Curitiba, in the south of Brazil. Many of them were dying of congestive heart failure, which caused their hearts to weaken and enlarge. Because he lacked the resources necessary for the standard American treatments for the disease--drug therapy and heart transplant--Batista needed to come up with a different solution. The one he finally adopted appears to be a relatively simple procedure, but it has shaken the world of cardiac surgery and offered new hope to people suffering from congestive heart failure. Batista's radical concept: Since the diseased heart is too big, why not cut off a slice or two and make it smaller?

Batista's procedure could not have come at a more propitious time. Each year congestive heart failure is diagnosed in hundreds of thousands of people. Though doctors are not certain, they believe these patients' hearts were impaired either by damage resulting from a heart attack or by a viral infection. When thus weakened, the heart tries to compensate by stretching its muscles to help it beat. But as the heart's muscular left ventricle expands, it becomes less efficient at pumping blood through the body. Patients in late-stage heart failure pump as little as 15% of the blood that enters the heart back into the body, compared with 65% to 70% for those with a healthy heart. Patients' symptoms include general feelings of weakness and shortness of breath as a result of the poor circulation.

What makes Batista's procedure so revolutionary and so controversial is the seeming paradox of cutting away heart muscle to make the heart stronger. As Batista boldly excises chunks of the heart (some pieces are the size of a normal heart) and sews the heart back together, surgeons around the world are watching with both skepticism and awe.