%0 Journal Article
%T Left Ventricular Outflow Tract Obstruction Following Aortic Valve Replacement: A Review of Risk Factors, Mechanism, and Management
%A Ira Balakrishnan
%A Neeti Makhija
%A Parag Gharde
%A Rohan Magoon
%A Sambhunath Das
%A Vishwas Malik
%J Archive of "Annals of Cardiac Anaesthesia".
%D 2019
%R 10.4103/aca.ACA_226_17
%X 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
%K Aortic valve replacement
%K asymmetrical septal hypertrophy
%K left ventricular outflow tract obstruction
%K mitral systolic anterior motion
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350428/