Makhija Neeti, Magoon Rohan, Balakrishnan Ira, Das Sambhunath, Malik Vishwas, Gharde Parag
Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India.
Ann Card Anaesth. 2019 Jan-Mar;22(1):1-5. doi: 10.4103/aca.ACA_226_17.
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.
动态左心室流出道梗阻（LVOTO）的存在会使接受外科主动脉瓣置换术（AVR）的患者术后病程复杂化。LVOTO现象是多种病理解剖机制相互作用的结果。除了解剖学危险因素外，主要的心血管环境决定了所产生的LVOTO的血流动力学意义。全面了解梗阻的易感因素、机制和血流动力学后果对于处理这些病例至关重要。全面的超声心动图检查有助于术后LVOTO情况下的风险预测、诊断、严重程度评估以及管理效果的随访。管理方式包括保守（药物）和手术选择。应根据易导致LVOTO的生理和解剖基础制定逐步的方法。该指标现象的发生频率比人们意识到的更高，当AVR术后患者出现对传统支持措施无反应的血流动力学不稳定时应予以考虑。本文概述了在接受AVR患者的围手术期管理背景下这种未被充分认识现象的各种特点。
