The usual causes of left ventricular outflow tract obstruction below the aortic valve in normal ventriculoarterial connection: Review of the physiopathology and surgical implications
subaortic stenosis; left ventricular outflow tract (LVOT); obstructive cardiomyopathy
Abstract :
[en] Subaortic narrowing leading to left ventricular outflow tract obstruction (LVOTO) is a significant pathology that may be encountered pre- or postoperatively in both acquired or congenital cardiac disease. Through a review of the morphological features and mechanisms in the different clinical situations, the anatomic, dynamic and mixed forms of subaortic obstruction are emphasized. Knowledge of the substrate of LVOTO, its physiopathology and natural history allows to plan accordingly the surgical repair and the postoperative management.
Disciplines :
Cardiovascular & respiratory systems Surgery
Author, co-author :
RADERMECKER, Marc ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie cardio-vasculaire
CANIVET, Jean-Luc ; Centre Hospitalier Universitaire de Liège - CHU > Soins intensifs
Limet, Raymond ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique
Language :
English
Title :
The usual causes of left ventricular outflow tract obstruction below the aortic valve in normal ventriculoarterial connection: Review of the physiopathology and surgical implications
MARON B., NICHOLS P., PICKLE L., WESLEY Y., MULVIHILL J. Patterns of inheritance in hypertrophic cardiomyopathy : assessment by M-mode and 2-dimensional echocardiography. Am J Cardiol, 1984, 53 : 1087-1094.
GEISTERFER-LOWRANCE A., KASS S., TAANIGAWA G., VOSBERG H. P., MCKENNA W., SEIDMAN C. E., SEIDMAN J. G. A molecular basis for familial hypertrophic cardiomyopathy : a b cardiac myosin heavy chain gene missense mutation. Cell, 1990, 62 : 999-1006.
THIERFELDER L., WATKINS H., MACRAE C., LAMAS R., MCKENNA W., VOSBERG H. P., SEIDMAN J. G., SEIDMAN C. E. αTropomyosin and cardiac troponin T mutations cause familial hypertrophic cardiomyopathy : a disease of the sarcomere. Cell, 1994, 77 : 701-702.
WIGLE E. D., SASSON Z., HENDERSON M. A., RUDDY T. D., FULOP J., RAKOWSKI H., WILLIAMS W. G. Hypertrophic cardiomyopathy : the importance of the site and the extent of hypertrophy. A review. Prog Cardiovasc Dis, 1985, 28 : 1-83.
KLUES G. H., MARON B. J., DOLLAR A. L., ROBERTS W. C. Diversity of structural mitral valve alterations in hypertrophic cardiomyopathy. Circulation, 1992, 85 : 1651-1660.
SHERRID M. V., CHU C. K., DELIA E., MOGTADER A., DWYER E. M. An echocardiographic study of fluid mechanics of obstruction in hypertrophic cardiomyopathy. JACC, 1993, 3 : 816-825.
YACOUB M., ONUZO O., RIEDEL B., RADLEY-SMITH R. Mobilization of the left and right fibrous trigones for relief of severe left ventricular outflow obstruction. J Thorac Cardiovasc Surg, 1999, 117 : 126-133.
LEWIS J. F., MARON B. J. Clinical and morphologic expression of hypertrophic cardiomyopathy in patients ≥ 65 years of age. Am J Cardiol, 1994, 73 : 1005-1111.
TOPOL E. J., TRAILL T. A., FORTUIN N. J. Hypertensive hypertrophic cardiomyopathy in the elderly. N Engl J Med, 1985, 312 : 277-283.
GOOR D., LILLEHEI C. W., EDWARDS J. E. The "sigmoid septum" variation in the contour of the left ventricular outlet. AJR Am J Roentgenol, 1969, 107 : 366-376.
DALLDORF F. G., WILLIS P. Angled aorta ("sigmoid septum") as a cause of hypertrophic subaortic stenosis. Hum Pathol, 1985, 16 : 457-462.
MORROW A. G. Hypertrophic subaortic stenosis. Operative methods utilized to relieve left ventricular outflow obstruction. J Thorac Cardiovasc Surg, 1978, 76 : 423-430.
SCHOENDUBE F. A., KLUES H. G., REITH S., FLACHSKAMPF F. A., HANRATH P., MESSMER B. J. Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. Circulation, 1995, 92 II : 122-127.
COOLEY D. A., WUKASCH D. C., LEACHMAN R. D. Mitral valve replacement for idiopathic hypertrophic subaortic stenosis. J Cardiovasc Surg, 1976, 17 : 380-387.
JEANRENAUD X., GOY J. J., KAPPENBERGER L. Effects of dual-chamber pacing in hypertrophic obstructive cardiomyopathy. Lancet, 1992, 339 : 1318-1323.
MARON B. J., NISHIMURA R. A., MCKENNA W. J., RAKOWSKI H., JOSEPHSON M. E., KIEVAL R. S. Assessment of permanent dual-chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-PATHY). Circulation, 1999, 99 : 2927-2933.
FABER L., MEISSNER A., ZIEMSSEN P., SEGGEWISS H. Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy : long term follow up of the first series of 25 patients. Heart, 2000, 83 : 326-331.
GROSSI E. A., GALLOWAY A. C., PARISH M. A. Experience with twenty-eight cases of systolic anterior motion after mitral valve reconstruction by the Carpentier technique. J Thorac Cardiovasc Surg, 1992, 103 : 466-470.
OMOTO T., MATSUMURA M., ASANO H., KYO S., TAKAMOTO S., YOKOTE Y., WONG M. Doppler ultrasound examination of prosthethic function and ventricular blood flow after mitral valve replacement. Herz, 1986, 11 : 346-350.
DE CANNIERE D., JANSSENS J. J., UNGER P., LECLERC T. L. Left ventricular outflow tract obstruction after mitral valve replacement. Ann Thorac Surg, 1997, 64 : 1805-1806.
JEBARA V. A., MIHAILENU S., ACAR C., BRIZARD C., GRARE P., LATREMOUILLE Ch., CHAUVAUD S., FABIANI J. N., DELOCHE A., CARPENTIER A. Left ventricular outflow tract obstruction after mitral valve repair. Results of the sliding leaflet technique. Circulation, 1993, 88 (5, 2) : 30-34.
CARPENTIER A. The sliding leaflet technique. Club Mitrale Newsletter, 1988 : 1-5.
VAN HERWERDEN L. A., FRASER A. G., BOS E. S. Left ventricular outflow tract obstruction after mitral valve repair assessed with intraoperative echocardiography : non interventional treatment. J Thorac Cardiovasc Surg, 1991, 102 : 461-463.
LAURENT M., LEBORGNE O., LEMENT C., FOULGOC J. L., LE HELLOCO A., ALMANGE C., LEBORGNE P. Systolic intra-cavitary gradients following aortic valve replacement : an echo-Doppler study. Eur Heart J, 1991, 12 : 1098-1106.
CANIVET J. L., DAMAS P., LAMY M. Left ventricular geometry of patients with cardiogenic shock after cardiac surgery despite supranormal systolic function. (abstract). Chest, 1995, 108 (3) suppl. : 219S.
AURIGEMMA G., BATTISTA S., ORSINELLI D., SWEENEY A., PAPE L., CUENOUD H. Abnormal left ventricular intracavitary flow acceleration in patients undergoing aortic valve replacement for aortic stenosis. A marker for high postoperative morbidity and mortality. Circulation, 1992, 86 (3) : 926-936.
FREEDOM R., PELECH A., BRAND A. et al. The progressive nature of subaortic stenosis in congenital heart disease. Int J Cardiol, 1985, 8 : 137-143.
NEWFELD E., MUSTER A., PAUL M., IDRISS F., RIKER W. Discrete subvalvar aortic stenosis in childhood. Am J Cardiol, 1976, 38 : 53-61.
LEICHTER D. A., SULLIVAN I. D., GERSONY W. M. "Acquired" discrete subvalvular aortic stenosis : natural history and hemodynamics. J Am Coll Cardiol, 1989, 14 : 1539-1544.
ROSENQUIST G., CLARK E., MCALLISTER H., BHARATI S., EDWARDS J. Increased mitral-aortic separation in discrete subaortic stenosis. Circulation, 1979, 60 : 70-74.
SHANER R. Malformation of the atrio-ventricular endocardial cushions of the embryo pig and its relation to the defects of the conus and truncus arteriosus. Am J Anat, 1949, 84 : 431-439.
CHOI J., SULLIVAN I. Fixed subaortic stenosis : anatomical spectrum and nature of progression. Br Heart J, 1991, 65 : 280-286.
GEWILLIG M., DAENEN W., DUMOULIN M., VAN DER HAUWAERT L. Rheologie genesis of discrete subvalvular aortic stenosis : a Doppler echocardiographic study. JACC, 1992, 19 (4) : 818-824.
KLEINERT S., GEVA T. Echocardiographic morphometry of the left ventricular outflow tract in fixed subaortic stenosis. JACC, 1993, 22 (5) : 1501-1508.
SOMERVILLE J. Fixed subaortic stenosis : a frequently misunderstood lesion. Int J Cardiol, 1958, 8 : 145-148.
SOMERVILLE J. Aortic stenosis and incompetence. In : Paediatric Cardiology. ANDERSON R. H., MACARTNEY F. J., SHINEBOURNE E. A., TYNAN M. (eds.). London, Churchill Livingstone, 1987 : pp. 987-992.
STARK J., DELEVAL M. R. Surgery of the left ventricular outflow tract. In : Surgery for congenital heart defects. 2nd Ed, WB Saunders Co, 1983.
KONNO S., IMAI Y., JIDA Y., NAKAJIMA M., TATSUNO K. A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring. J Thorac Cardiovasc Surg, 1975, 70 : 909-917.
VOUHE P. R., NEVEUX J. Y. Surgical management of diffuse subaortic stenosis : An integrated approach. Ann Thorac Surg, 1991, 52 : 654-662.
DAENEN W. J., VANHOVE M. A., GEWILLIG M. H. Extended aortic root replacement with pulmonary autografts : experience in 14 cases. Ann Thorac Surg, 1995, 60 : S180-S183.
SOMERVILLE J. Atrioventricular defects : natural and unnatural history. In : GODMAN M. (ed.). Paediatric cardiology. Edinburgh : Churchill Livingstone, 1980.
DELEON S. Y., ILBAWI M. N., WILSON W. R. et al, Surgical options in subaortic stenosis associated with endocardial cushion defects. Ann Thorac Surg, 1991, 52 : 1076-1083.
BLIEDEN L. C., RANDALL P. A., CASTANEDA A. R., LUCAS R. V., EDWARDS J. E. The "goose neck" of the endocardial cushion defect : anatomic basis. Chest, 1974, 65 : 13-17.
EBELS T., HO S. Y., ANDERSON R. H., MEITBOOM E. T., IJGELAAR A. The surgical anatomy of the left ventricular outflow tract in atrioventricular septal defect. Ann Thorac Surg, 1986, 41 : 483-488.
LAPPEN R. S., MUSTER A. J., IDRISS F. S. et al. Masked subaortic stenosis in ostium primum atrial septal defect : recognition and treatment. Am J Cardiol, 1983, 52 : 336-340.
MACE L., DERVANIAN P., FOLLIGUET T., GRINDA J. M., LOSAY J., NEVEUX J. Y. Atrioventricular septal defect with native subaortic stenosis correction by extended valvular detachment. JJ Thorac Cardiovasc Surg, 1994, 107 (3) : 943-945.
STARR A., HOVAGUIMIAN H. Surgical repair of subaortic stenosis in atrioventricular canal defects. J Thorac Cardiovasc Surg, 1994, 108 : 373-376.
KIRKLIN T. W. & BARATT BOYES B. G. Coarctation of the aorta and interrupted aortic arch. In : Cardiac surgery, 2nd Ed, Churchill Livingstone, 1993.
SELL J. E., JONAS R. A., MAYER J. E., BLACKSTONE E. H., KIRKLIN T. W., CASTANEDA A. R. The results of a surgical program for interrupted aortic arch. J Thorac Cardiovasc Surg, 1988, 96 : 864-871.
WILCOX B. R., ANDERSON R. H. Surgical anatomy of the heart: arterial valve and outflow tract malformation. Churchill Livingstone, 1985.
FREED M. D., ROSENTHAL A., PLAUTH W. H. Jr, NADAS A. S. Development of subaortic stenosis after pulmonary artery banding. Circulation, 1973, 47/48 (Suppl 3) : 7.
BRADLEY S. M. Late renal cell carcinoma metastasis to the left ventricular outflow tract. Ann Thorac Surg, 1995, 60 (1) : 204-206.
NAGUEH S. F., OMMEN S. R., LAKKIS N. M., KILLIP D., ZOGHBI W. A., SCHAFF H. V., DANIELSON G. K., QUINONES M. A. TAJIK A. J., SPENCER W. H. Comparison of ethanol septal reduction therapy with surgical myectomy for thr treatment of hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol, 2001, 38 (6) : 1707-10.
