Left ventricular outflow tract obstruction following aortic valve replacement: A review of risk factors, mechanism, and management
Ann Card Anaesth
;
2019 Jan; 22(1): 1-5
Article
| IMSEAR
| ID: sea-185791
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.
Full text:
Available
Index:
IMSEAR (South-East Asia)
Type of study:
Etiology study
/
Prognostic study
/
Risk factors
Journal:
Ann Card Anaesth
Year:
2019
Type:
Article
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