Anesthetic Management of Patients with Left Ventricular Outflow Tract Obstruction Presenting for Noncardiac Surgery

Abstract

Left ventricular outflow tract is the region just below the aortic valve, actually the region through which blood moves out of the left ventricle. It is bounded by the inter-ventricular septum in the front and the anterior mitral leaflet in back. Left ventricular outflow tract obstructions (LVO-TOs)encompass a series of stenotic lesions starting in the-anatomic left ventricular outflow tract (LVOT) and stretch-ingto the descending portion of the aortic arch.Obstruction may be subvalvar(subaortic stenosis), valvar, or supraval-var. Left ventricularoutflow tract obstruction can be defined as either fixed ordynamic obstruction to ejection of blood from the leftventricle. Although the clinical manifestations aresimilar to those of left ventricular systolic dysfunction, thediagnosis of LVOTO is critical because the treatment andmanagement are based on a very different rationale.Indeed, inotropic support, pharmacological or mechanicalafterload