Acute Left Ventricular Outflow Tract Obstruction in Non - Mitral Cardiovascular Surgery: A Case Series Analysis

Abstract

Objective: We aimed to analyze the clinical signs of left ventricular outflow tract obstruction and its management in the perioperative period of major non-mitral cardiovascular procedures. Design. Case series analysis. Methods and Results Thirteen (10 males, 3 females) patients aged 64 (56; 74) y.o. with acutely emerged left ventricular outflow tract obstruction during/after non-mitral cardiovascular procedure between May 2006 and May 2018 were included. Methods: The procedures were as follows: coronary artery bypass grafting – n=11, aortic valve replacement – n=1, abdominal aortic membrane resection (aortic dissection DeBakey type I, acute legs ischemia) – n=1. Left ventricular outflow tract obstruction with systolic anterior motion of anterior leaflet of mitral valve was detected in 0.9% of the total number of perioperative echocardiography examinations. Three variants of its clinical course were described: (1) intracardiac and systemic hemodynamics recovery with a specific therapy (most cases); (2) full resistance to therapy with sustainable systolic anterior motion persistence; (3) termination of systolic anterior motion as a result of the therapy, but the paradoxical persistence of low cardiac output syndrome. Conclusion: Practitioners’ vigilance and Echocardiographic monitoring are needed for early detection of acute left ventricular outflow tract obstruction. Its development can be a marker of the extremely hard concentric left ventricular hypertrophy as a cause of the low cardiac output syndrome.