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| ==Recommendation for Medical Therapy for Left Ventricular Outflow Tract Obstruction and Associated Lesions (DO NOT EDIT)== | | ==Recommendation for Medical Therapy for Left Ventricular Outflow Tract Obstruction and Associated Lesions (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref>== |
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Revision as of 17:39, 9 November 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: LV outflow tract obstruction; LVOT obstruction
Overview
Left ventricular outflow tract obstruction refers to any functional or anatomic obstruction of flow out of the left ventricle.
Causes
2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[1]
Recommendations for Evaluation of the Unoperated Patient (DO NOT EDIT)[1]
Recommendation for Medical Therapy for Left Ventricular Outflow Tract Obstruction and Associated Lesions (DO NOT EDIT)[1]
| Class III
|
| 1. Vasodilator therapy is not indicated for long-term therapy in AR for the following:
|
| a. The asymptomatic patient with only mild to moderate AR and normal LV function. (Level of Evidence: B)
|
| b. The asymptomatic patient with LV systolic dysfunction who is otherwise a candidate for aortic valve replacement (AVR). (Level of Evidence: B)
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| c. The asymptomatic patient with either LV systolic function or mild to moderate LV diastolic dysfunction who is otherwise a candidate for AVR. (Level of Evidence: C)
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| Class IIa
|
| 1. It is reasonable to treat systemic hypertension in patients with AS while monitoring diastolic blood pressure to avoid reducing coronary perfusion. (Level of Evidence:C)
|
| 2. It is reasonable to administer beta blockers in patients with BAV and aortic root dilatation. (Level of Evidence:C)
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| 3. It is reasonable to use long-term vasodilator therapy in patients with AR and systemic hypertension while carefully monitoring diastolic blood pressure to avoid reducing coronary perfusion. (Level of Evidence:C)
|
| Class IIb
|
| 1. It may be reasonable to treat patients with BAV and risk factors for atherosclerosis with statins with the aim of ‘‘slowing down degenerative changes in the aortic valve and preventing atherosclerosis. (Level of Evidence:C)
|
ACC/ AHA Guidelines - Recommendations for Catheter Interventions for Adults With Valvular Aortic Stenosis (DO NOT EDIT)
| Class I
|
| 1. In young adults and others without significantly calcified aortic valves and no AR, aortic balloon valvotomy
is indicated in the following patients. (Level of Evidence: A)
|
| a. Those with symptoms of angina, syncope, dyspnea on exertion, and peak-to-peak gradients at catheterization greater than 50 mm Hg. (Level of Evidence: A)
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| b. Asymptomatic adolescents or young adults who demonstrate ST or T-wave abnormalities in the left precordial leads on ECG at rest or with exercise and a peak-to-peak catheter gradient greater than 60 mm Hg. (Level of Evidence: A)
|
| Class III (No Benefit)
|
| 1. In older adults, aortic balloon valvotomy is not recommended as an alternative to AVR, although certain younger patients may be an exception and should be referred to a center with experience in aortic balloon valvuloplasties (Level of Evidence: B)
|
| 2. In asymptomatic adolescents and young adults, aortic balloon valvotomy should not be performed with a peak-to-peak gradient less than 40 mm Hg without symptoms or ECG changes. (Level of Evidence: B)
|
| Class IIa
|
| 1. Aortic balloon valvotomy is reasonable in the asymptomatic adolescent or young adult with AS and a peak-to-peak gradient on catheterization greater than 50 mm Hg when the patient is interested in playing competitive sports or becoming pregnant. (Level of Evidence:C)
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| Class IIb
|
| 1. Aortic balloon valvotomy may be considered as a bridge to surgery in hemodynamically unstable adults with AS, adults at high risk for AVR, or when AVR cannot be performed secondary to significant co-morbidities. (Level of Evidence:C)
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References
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