Desai Manan
Pediatric Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, CA 94304 Palo Alto, USA.
Indian J Thorac Cardiovasc Surg. 2021 Jan;37(Suppl 1):123-130. doi: 10.1007/s12055-020-01122-9. Epub 2021 Jan 15.
The left ventricular outflow tract (LVOT) comprises of the subvalvular area, the aortic valve, and the supravalvular region. Obstructive lesion of LVOT is a spectrum with varying levels and degree of obstruction with or without associated hypoplasia of the left ventricle. Decision-making in small and borderline LVOT can be challenging. Imaging modalities such as echocardiography and magnetic resonance imaging and scores based on imaging aid in the decision making in truly borderline cases. Newer treatment strategies like staged left ventricular rehabilitation and hybrid procedure have come to the fore in the past decade or so. Although these do not address small LVOT per se, they delay the decision-making to a more appropriate age. The goal of management in these cases is to achieve a biventricular repair whenever feasible. Several surgical techniques could be employed to achieve this goal. However, it is important to be cognizant of the fact that an overzealous approach to achieve a biventricular repair might be counterproductive. A univentricular palliation could be a safer alternative; especially considering the possibility of a future transplant candidacy.
左心室流出道（LVOT）由瓣下区域、主动脉瓣和瓣上区域组成。LVOT梗阻性病变是一种具有不同梗阻水平和程度的谱系，伴有或不伴有左心室相关发育不全。小型和临界LVOT的决策可能具有挑战性。超声心动图和磁共振成像等成像方式以及基于成像的评分有助于真正临界病例的决策。在过去十年左右的时间里，诸如分期左心室康复和杂交手术等新的治疗策略已崭露头角。尽管这些策略本身并不能解决小型LVOT问题，但它们将决策推迟到更合适的年龄。这些病例的管理目标是在可行的情况下实现双心室修复。可以采用几种手术技术来实现这一目标。然而，必须认识到，过度积极地进行双心室修复可能会适得其反。单心室姑息治疗可能是一种更安全的选择；特别是考虑到未来有移植候选资格的可能性。
