Year : 2019  |  Volume : 22  |  Issue : 1  |  Page : 1--5

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


Neeti Makhija, Rohan Magoon, Ira Balakrishnan, Sambhunath Das, Vishwas Malik, Parag Gharde 
 Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Neeti Makhija
Department of Cardiac Anaesthesia, Room No. 9, 7th Floor, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India

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.


How to cite this article:
Makhija N, Magoon R, Balakrishnan I, Das S, Malik V, Gharde P. Left ventricular outflow tract obstruction following aortic valve replacement: A review of risk factors, mechanism, and management.Ann Card Anaesth 2019;22:1-5


How to cite this URL:
Makhija N, Magoon R, Balakrishnan I, Das S, Malik V, Gharde P. Left ventricular outflow tract obstruction following aortic valve replacement: A review of risk factors, mechanism, and management. Ann Card Anaesth [serial online] 2019 [cited 2019 May 25 ];22:1-5
Available from: http://www.annals.in/article.asp?issn=0971-9784;year=2019;volume=22;issue=1;spage=1;epage=5;aulast=Makhija;type=0