Left Ventricular Outflow Tract Obstruction (LVOTO)

Left Ventricular Outflow Tract Obstruction (LVOTO) is a recognised feature of Hypertrophic Cardiomyopathy and is caused by the thickened heart muscle and the abnormal movement of the mitral valve; this is the main mechanism of debilitating symptoms in Hypertrophic Cardiomyopathy patients. It is also one of the risk factors for sudden cardiac death, especially in young patients.

Causes

Hypertrophic Cardiomyopathy is the single most common form of inherited heart disease. Left ventricular outflow tract obstruction (LVOTO) is a recognised feature of this condition which arises when blood leaving the outflow tract is impeded by systolic anterior motion of the mitral valve. In an important minority of patients, breathlessness, chest pain and loss of consciousness may occur despite the use of medication.

Symptoms

Left Ventricular Outflow Tract Obstruction (LVOTO) can present anyof the following symptoms;

  • Breathlessness with activity
  • Light-headedness, especially with or after activity or exercise
  • Fainting or near fainting
  • Palpitations
  • Chest pain with activity

Diagnosis

The diagnosis of LVOTO rests upon the detection of increase thickness of the left ventricular wall which can be measure by imaging techniques such as Echocardiography, Cardiac magnetic Resosnance imaging (CMR) or Computed Tomography (CT) that is not explained solely by any loading conditions of the heart.

Treatment

The Left ventricular outflow tract obstruction management programme at the Royal Brompton and Harefield Hospital offer a holistic approach to the treatment and management of the condition. The programme offers the highest level of diagnostic expertise and all internationally available management options. There are currently two techniques available if medication does not deliver the desire results, alcohol septal ablation and surgical myectomy.

Surgical Myectomy
In suitable candidates, surgery may relieve obstruction and its associated symptoms. This procedure entails surgical muscle resection after specialist imaging to access the obstruction and the anatomy of the left ventricle and the mitral valve. During the procedure the surgeon will reach the inside of the heart through the aorta and aortic valve to resect the inner surface of the heart muscle to relieve blockage in the areas which are thickened. Occasionally, the resection of the muscle is not sufficient and then a repair or replacement of the mitral valve may become necessary.

Alcohol Septal Ablation
Alcohol Septal Ablation (ASA) is a nonsurgical reduction of the thickness of the ventricular muscle in the area of the outflow tract, and is a clinically efficient therapeutic option in selected cases. The procedure involves the tip of a catheter being wedged into a small artery that supplies blood to the thick muscle. Then the area of blood supply is carefully checked with specialised imaging. If appropriate, an infarction is generated in the area by injecting a small amount of ethanol through the catheter. This results in scarring and shrinking of the wall thickness reducing or even eliminating the obstruction. The improvement may not manifest itself immediately after the procedure.

Benefits of successful LVOTO Treatment

Patients who have had successful LVOTO treatment will experience relief from symptoms such as fainting, fatigue and breathlessness as well as reduced risk of sudden cardiac arrest (particularly in young patients) resulting in a dramatic improvement in patients quality of life and lowered risk of other complications related to LVOTO.

Consultants linked to treatment

Dr Antonis Pantazis
Mr Fabio De Robertis
Mr J. Andreas Hoschtitzky

Location where service is offered:

Royal Brompton Hospital and Harefield Hospital

 

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