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Ventricular Outflow Obstruction

MedGen UID:
52999
•Concept ID:
C0042512
•
Disease or Syndrome
Synonyms: Obstruction, Ventricular Outflow; Outflow Obstruction, Ventricular; Ventricular Outflow Obstructions

Definition

Occlusion of the outflow tract in either the LEFT VENTRICLE or the RIGHT VENTRICLE of the heart. This may result from CONGENITAL HEART DEFECTS, predisposing heart diseases, complications of surgery, or HEART NEOPLASMS. [from MeSH]

Professional guidelines

PubMed

The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: Management of infants and neonates with tetralogy of Fallot.
Expert Consensus Panel:, Miller JR, Stephens EH, Goldstone AB, Glatz AC, Kane L, Van Arsdell GS, Stellin G, Barron DJ, d'Udekem Y, Benson L, Quintessenza J, Ohye RG, Talwar S, Fremes SE, Emani SM, Eghtesady P
J Thorac Cardiovasc Surg 2023 Jan;165(1):221-250. Epub 2022 Oct 26 doi: 10.1016/j.jtcvs.2022.07.025. PMID: 36522807
Canadian Cardiovascular Society 2022 Guidelines for Cardiovascular Interventions in Adults With Congenital Heart Disease.
Marelli A, Beauchesne L, Colman J, Ducas R, Grewal J, Keir M, Khairy P, Oechslin E, Therrien J, Vonder Muhll IF, Wald RM, Silversides C, Barron DJ, Benson L, Bernier PL, Horlick E, Ibrahim R, Martucci G, Nair K, Poirier NC, Ross HJ, Baumgartner H, Daniels CJ, Gurvitz M, Roos-Hesselink JW, Kovacs AH, McLeod CJ, Mulder BJ, Warnes CA, Webb GD
Can J Cardiol 2022 Jul;38(7):862-896. Epub 2022 Apr 20 doi: 10.1016/j.cjca.2022.03.021. PMID: 35460862
Echocardiography in shock management.
McLean AS
Crit Care 2016 Aug 20;20:275. doi: 10.1186/s13054-016-1401-7. PMID: 27543137Free PMC Article

Recent clinical studies

Etiology

Obstruction in Hypertrophic Cardiomyopathy: Many Faces.
Abbasi M, Ong KC, Newman DB, Dearani JA, Schaff HV, Geske JB
J Am Soc Echocardiogr 2024 Jun;37(6):613-625. Epub 2024 Feb 28 doi: 10.1016/j.echo.2024.02.010. PMID: 38428652
Multimodality imaging of hypertrophic cardiomyopathy.
Dong T, Gilliland Y, Kramer CM, Theodore A, Desai M
Prog Cardiovasc Dis 2023 Sep-Oct;80:14-24. Epub 2023 Aug 14 doi: 10.1016/j.pcad.2023.08.004. PMID: 37586654
Imaging of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.
Stewart M, Elagizi A, Gilliland YE
Curr Opin Cardiol 2023 Sep 1;38(5):405-414. Epub 2023 Apr 6 doi: 10.1097/HCO.0000000000001058. PMID: 37115813
Genetic and Developmental Contributors to Aortic Stenosis.
Dutta P, James JF, Kazik H, Lincoln J
Circ Res 2021 Apr 30;128(9):1330-1343. Epub 2021 Apr 29 doi: 10.1161/CIRCRESAHA.120.317978. PMID: 33914609Free PMC Article
Hypertrophic Cardiomyopathy and Left Ventricular Outflow Tract Obstruction: Expecting the Unexpected.
Jain P, Patel PA, Fabbro M 2nd
J Cardiothorac Vasc Anesth 2018 Feb;32(1):467-477. Epub 2017 May 1 doi: 10.1053/j.jvca.2017.04.054. PMID: 28967624

Diagnosis

Multimodality imaging of hypertrophic cardiomyopathy.
Dong T, Gilliland Y, Kramer CM, Theodore A, Desai M
Prog Cardiovasc Dis 2023 Sep-Oct;80:14-24. Epub 2023 Aug 14 doi: 10.1016/j.pcad.2023.08.004. PMID: 37586654
Arrhythmia Evaluation and Management.
Jacobson JT
Cardiol Clin 2019 Feb;37(1):55-62. Epub 2018 Oct 29 doi: 10.1016/j.ccl.2018.08.005. PMID: 30447716
Hypertrophic Cardiomyopathy and Left Ventricular Outflow Tract Obstruction: Expecting the Unexpected.
Jain P, Patel PA, Fabbro M 2nd
J Cardiothorac Vasc Anesth 2018 Feb;32(1):467-477. Epub 2017 May 1 doi: 10.1053/j.jvca.2017.04.054. PMID: 28967624
The Brockenbrough-Braunwald-Morrow sign.
Trevino AR, Buergler J
Methodist Debakey Cardiovasc J 2014 Jan-Mar;10(1):34-7. doi: 10.14797/mdcj-10-1-34. PMID: 24932361Free PMC Article
The diagnosis of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.
Piva e Mattos B, Torres MA, Rebelatto TF, Loreto MS, Scolari FL
Arq Bras Cardiol 2012 Jul;99(1):665-75. doi: 10.1590/s0066-782x2012000700013. PMID: 22948303

Therapy

Aficamten for Symptomatic Obstructive Hypertrophic Cardiomyopathy.
Maron MS, Masri A, Nassif ME, Barriales-Villa R, Arad M, Cardim N, Choudhury L, Claggett B, Coats CJ, Düngen HD, Garcia-Pavia P, Hagège AA, Januzzi JL, Lee MMY, Lewis GD, Ma CS, Michels M, Olivotto I, Oreziak A, Owens AT, Spertus JA, Solomon SD, Tfelt-Hansen J, van Sinttruije M, Veselka J, Watkins H, Jacoby DL, Heitner SB, Kupfer S, Malik FI, Meng L, Wohltman A, Abraham TP; SEQUOIA-HCM Investigators
N Engl J Med 2024 May 30;390(20):1849-1861. Epub 2024 May 13 doi: 10.1056/NEJMoa2401424. PMID: 38739079
Multimodality imaging of hypertrophic cardiomyopathy.
Dong T, Gilliland Y, Kramer CM, Theodore A, Desai M
Prog Cardiovasc Dis 2023 Sep-Oct;80:14-24. Epub 2023 Aug 14 doi: 10.1016/j.pcad.2023.08.004. PMID: 37586654
Randomized Trial of Metoprolol in Patients With Obstructive Hypertrophic Cardiomyopathy.
Dybro AM, Rasmussen TB, Nielsen RR, Andersen MJ, Jensen MK, Poulsen SH
J Am Coll Cardiol 2021 Dec 21;78(25):2505-2517. doi: 10.1016/j.jacc.2021.07.065. PMID: 34915981
Arrhythmia Evaluation and Management.
Jacobson JT
Cardiol Clin 2019 Feb;37(1):55-62. Epub 2018 Oct 29 doi: 10.1016/j.ccl.2018.08.005. PMID: 30447716
The Brockenbrough-Braunwald-Morrow sign.
Trevino AR, Buergler J
Methodist Debakey Cardiovasc J 2014 Jan-Mar;10(1):34-7. doi: 10.14797/mdcj-10-1-34. PMID: 24932361Free PMC Article

Prognosis

Incidence and management of the left ventricular outflow obstruction in patients with atrioventricular septal defects.
Ivanov Y, Buratto E, Naimo P, Lui A, Hu T, d'Udekem Y, Brizard CP, Konstantinov IE
Interact Cardiovasc Thorac Surg 2022 Mar 31;34(4):604-610. doi: 10.1093/icvts/ivab303. PMID: 34751750Free PMC Article
Predictors of Left Ventricular Outflow Tract Obstruction After Primary Interrupted Aortic Arch Repair.
Korsuize NA, van Wijk A, Haas F, Grotenhuis HB
Pediatr Cardiol 2021 Dec;42(8):1665-1675. Epub 2021 Aug 2 doi: 10.1007/s00246-021-02689-9. PMID: 34338828Free PMC Article
Factors influencing left ventricular outflow tract obstruction following a mitral valve-in-valve or valve-in-ring procedure, part 1.
Bapat V, Pirone F, Kapetanakis S, Rajani R, Niederer S
Catheter Cardiovasc Interv 2015 Oct;86(4):747-60. doi: 10.1002/ccd.25928. PMID: 26386239
Management of outflow tract ventricular arrhythmias.
Maury P, Rollin A, Mondoly P, Duparc A
Curr Opin Cardiol 2015 Jan;30(1):50-7. doi: 10.1097/HCO.0000000000000122. PMID: 25389648
Echocardiographic evaluation of congenital left ventricular outflow obstruction.
Aboulhosn J, Child JS
Echocardiography 2015 Jan;32 Suppl 2:S140-7. Epub 2014 May 29 doi: 10.1111/echo.12181. PMID: 24891121

Clinical prediction guides

Latent outflow tract obstruction in hypertrophic cardiomyopathy: Clinical characteristics and outcomes of septal myectomy.
Cui H, Schaff HV, Nishimura RA, Dearani JA, Geske JB, Ommen SR
J Thorac Cardiovasc Surg 2022 Dec;164(6):1863-1869.e1. Epub 2020 Dec 10 doi: 10.1016/j.jtcvs.2020.12.016. PMID: 33468328
Randomized Trial of Metoprolol in Patients With Obstructive Hypertrophic Cardiomyopathy.
Dybro AM, Rasmussen TB, Nielsen RR, Andersen MJ, Jensen MK, Poulsen SH
J Am Coll Cardiol 2021 Dec 21;78(25):2505-2517. doi: 10.1016/j.jacc.2021.07.065. PMID: 34915981
Left ventricular outflow tract obstruction in ICU patients.
Slama M, Tribouilloy C, Maizel J
Curr Opin Crit Care 2016 Jun;22(3):260-6. doi: 10.1097/MCC.0000000000000304. PMID: 27054628
Hypertrophic cardiomyopathy: a review.
Hensley N, Dietrich J, Nyhan D, Mitter N, Yee MS, Brady M
Anesth Analg 2015 Mar;120(3):554-569. doi: 10.1213/ANE.0000000000000538. PMID: 25695573
The Brockenbrough-Braunwald-Morrow sign.
Trevino AR, Buergler J
Methodist Debakey Cardiovasc J 2014 Jan-Mar;10(1):34-7. doi: 10.14797/mdcj-10-1-34. PMID: 24932361Free PMC Article

Recent systematic reviews

Absent pulmonary valve with tricuspid atresia/stenosis: literature review with new three long-term cases.
Kawasaki Y, Murakami Y, Fujino M, Sasaki T, Nakamura K, Yoshida Y, Suzuki T, Nishigaki K, Ehara E
Heart Vessels 2022 Jan;37(1):142-151. Epub 2021 Jun 5 doi: 10.1007/s00380-021-01887-y. PMID: 34089363
Outcomes following the surgical management of left ventricular outflow tract obstruction; A systematic review and meta-analysis.
Collis RA, Rahman MS, Watkinson O, Guttmann OP, O'Mahony C, Elliott PM
Int J Cardiol 2018 Aug 15;265:62-70. doi: 10.1016/j.ijcard.2018.01.130. PMID: 29885701
Left ventricular aneurysms in hypertrophic cardiomyopathy with midventricular obstruction: A systematic review of literature.
Elsheshtawy MO, Mahmoud AN, Abdelghany M, Suen IH, Sadiq A, Shani J
Pacing Clin Electrophysiol 2018 Jul;41(7):854-865. Epub 2018 Jun 20 doi: 10.1111/pace.13380. PMID: 29786883
Homograft reconstruction of the right ventricular outflow tract in adults with congenital heart disease: a systematic review.
Skoglund K, Eriksson P, Svensson G, Dellborg M
Interact Cardiovasc Thorac Surg 2016 Jan;22(1):57-62. Epub 2015 Sep 27 doi: 10.1093/icvts/ivv264. PMID: 26415536
Radiofrequency catheter ablation for the treatment of idiopathic premature ventricular contractions originating from the right ventricular outflow tract: a systematic review and meta-analysis.
Lamba J, Redfearn DP, Michael KA, Simpson CS, Abdollah H, Baranchuk A
Pacing Clin Electrophysiol 2014 Jan;37(1):73-8. Epub 2013 Aug 26 doi: 10.1111/pace.12243. PMID: 23980900

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