Dynamic left ventricular outflow tract obstruction following surgical aortic valve replacement is an under-recognized complication requiring a stepwise management approach based on patient substrates.
This review highlights the under-recognized phenomenon of dynamic LVOTO post-AVR, emphasizing the importance of echocardiography for diagnosis and a stepwise approach to medical and surgical management.
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.
Makhija et al. (Tue,) conducted a review in Left ventricular outflow tract obstruction following surgical aortic valve replacement. Dynamic left ventricular outflow tract obstruction following surgical aortic valve replacement is an under-recognized complication requiring a stepwise management approach based on patient substrates.