Dynamic left ventricular outflow tract obstruction in an orthotopic liver transplant recipient

2005 ◽  
Vol 11 (6) ◽  
pp. 692-695 ◽  
Author(s):  
Jacek B. Cywinski ◽  
Maged Argalious ◽  
Theodore N. Marks ◽  
Brian M. Parker
Keyword(s):  
Transplant Recipient ◽  
Liver Transplant ◽  
Left Ventricular Outflow Tract ◽  
Liver Transplant Recipient ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Orthotopic Liver Transplant ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

P3465Inducible left ventricular outflow tract obstruction is associated with a higher incidence of perioperative cardiac arrest in liver transplantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Cailes ◽  
A N Koshy ◽  
H Han ◽  
J K Sajeev ◽  
J Ko ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cardiac Arrest ◽  
Liver Transplant ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

Abstract Background Inducible left ventricular outflow tract obstruction (LVOTO) is not infrequently encountered in liver transplant (LT) candidates undergoing cardiac workup. While the impact of LVOTO on adverse cardiovascular haemodynamics is well reported, it is unclear whether it predisposes to perioperative cardiovascular complications following LT. Purpose To investigate the effect of inducible left ventricular outflow tract obstruction on perioperative cardiovascular complications in a modern cohort of liver transplant patients. Methods Consecutive patients undergoing dobutamine stress echocardiography (DSE) were evaluated from a quaternary LT centre between 2010 and 2017. Inducible LVOTO was defined as LVOT gradient ≥36mmHg. Perioperative major adverse cardiovascular events (MACE) at 30 days and all-cause death were recorded from a prospectively maintained transplantation database and augmented by electronic medical record review. Results We evaluated 560 patients who underwent DSE as part of a workup for LT. Of these, 319 progressed to transplant. Inducible LVOTO was observed in 68 patients (21.3%). A higher baseline cardiac output (7.7 L/min vs 7.0 L/min, p=0.002) predicted for development of inducible LVOTO. Seventy-seven patients (4.1%) experienced a MACE including five deaths, 19 cases of heart failure, 11 cardiac arrests, 10 acute coronary syndromes and 46 cases of arrhythmias (VT/AF). Overall MACE occurred in 17/68 patients (25.0%) with LVOTO and 60/251 patients (23.9%) without LVOTO (p=0.85). However, there was a significantly increased risk of resuscitated perioperative cardiac arrest in patients with LVOTO (7.4% vs 2.4%, p=0.04). Patients with LVOTO also required significantly greater volumes of fluid intra-operatively (8.37L vs. 6.71L, p=0.043). Cardiac Arrest in LT Patients with LVOTO Conclusions Inducible LVOTO is a frequent finding occurring in 21.3% of LT candidates. Despite higher intraoperative fluid resuscitation, LVOTO increased the risk of a perioperative cardiac arrest. Further studies are required to confirm these findings and to assess whether patients with LVOTO undergoing liver transplantation may benefit from heightened perioperative surveillance.

scholarly journals Norepinephrine-associated left ventricular outflow tract obstruction and systolic anterior movement

2019 ◽  
Vol 12 (12) ◽  
pp. e225879 ◽  
Author(s):  
Warner Mbuila Mampuya ◽  
Jonathan Dumont ◽  
Francois Lamontagne
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Outflow Tract ◽  
Myocardial Hypertrophy ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Increase Blood Pressure ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Systolic Anterior Movement

In the perioperative setting, norepinephrine is used to increase blood pressure, an effect mediated mostly via arterial and venous vasoconstriction. Thus, norepinephrine is, allegedly, less likely to cause or worsen left ventricular outflow tract obstruction (LVOTO) than other inotropes. We report a case of norepinephrine-associated dynamic LVOTO and systolic anterior movement in a predisposed patient. This report highlights that unrecognised dynamic LVOTO may worsen shock parameters in patients treated with norepinephrine who have underlying myocardial hypertrophy.

scholarly journals Unstable angina complicated with dynamic left ventricular outflow tract obstruction

2021 ◽  
Vol 23 (4) ◽  
pp. 181-188
Author(s):  
Kazuyuki Ozaki ◽  
Takeshi Okubo ◽  
Kenichi Hagiya ◽  
Naoki Kubota ◽  
Keiichi Tsuchida ◽  
...  
Keyword(s):  
Unstable Angina ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow
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