Left ventricular outflow tract obstruction following aortic valve replacement: A review of risk factors, mechanism, and management

Abstract

The presence of dynamic left ventricular outflow tract obstruction (LVOTO) can complicate the postoperative course of patients undergoing surgical aortic valve replacement (AVR). The phenomenon of LVOTO is a consequence of an interplay of various pathoanatomic mechanisms. The prevailing cardiovascular milieu dictates the hemodynamic significance of the resultant LVOTO in addition to the anatomical risk factors. A thorough understanding of the predisposing factors, mechanism, and hemodynamic sequel of the obstruction is pivotal in managing these cases. A comprehensive echocardiographic examination aids in risk prediction, diagnosis, severity characterization, and follow-up of management efficacy in the setting of postoperative LVOTO. The armamentarium of management modalities includes conservative (medical) and surgical options. A stepwise approach should be formulated based on the physiological and anatomical substrates predisposing to LVOTO. The index phenomenon occurs more frequently than appreciated and should be considered when the post-AVR patients exhibit hemodynamic instability unresponsive to conventional supportive measures. The present article provides an overview of various peculiarities of this under-recognized phenomenon in the context of the perioperative management of patients undergoing AVR.

Urgent percutaneous transluminal septal myocardial ablation for left ventricular outflow tract obstruction exacerbated after surgical aortic valve replacement

“…The key issue issues in this case are that urgent PTSMA was applied to treat heart failure due to exacerbated LVOT obstruction after surgical AVR, which is an under-recognized cause of postoperative hemodynamic compromise (2).…”

Urgent percutaneous transluminal septal myocardial ablation for left ventricular outflow tract obstruction exacerbated after surgical aortic valve replacement

“…The key issues in this case are that urgent PTSMA was applied to treat heart failure due to exacerbated LVOT obstruction after surgical AVR, which is an under‑recognized cause of postoperative hemodynamic compromise. 2 …”

Unusual Cause of Stroke

“…It is estimated that 75% of cardiac myxomas arise within the left atrium. Other locations include the right atrium in 23% of cases and the ventricular cavity in 2% of cases [ 7 ]. This tumor affects mainly middle-aged female patients with a female-to-male ratio of 2 to 1 [ 6 ].…”