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Congenital Heart Disease: Left Ventricular Outflow Tract Obstruction

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Pediatric Critical Care Medicine

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Abstract

Left ventricular outflow tract obstruction represents a wide spectrum of disease, including subvalvar aortic stenosis, valvar aortic stenosis, supravalvar aortic stenosis, coarctation of the aorta, and interrupted aortic arch. In some cases, these disorders may manifest in the fetal and early neonatal period, requiring early medical management or urgent surgical or catheter-based intervention. Patients presenting later often have chronic left ventricular pressure overload, compensatory hypertrophy with altered ventricular diastolic properties, and arterial hypertension. Most of these conditions are easily diagnosed by physical examination, electrocardiography, chest radiography, and two-dimensional echocardiography with Doppler. Diagnostic catheterization may be helpful if the diagnosis is in question, for precise determination of pressure gradients, or for providing further anatomic detail via angiography. The threshold for invasive therapy varies with the location of the obstruction and its natural history. Catheter-based intervention is commonly utilized for valvar aortic stenosis and coarctation, with success rates varying based on disease type and location. Surgical intervention is indicated for interrupted aortic arch, certain types of valvar aortic stenosis and coarctation deemed not suitable for catheter-based intervention, and for subvalvar and supravalvar aortic stenosis of adequate severity. Lifelong follow-up is generally recommended, as recurrence requiring reintervention may occur.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI, 48109-4204, USA

    John R. Charpie MD, PhD, Dennis C. Crowley MD & Ranjit Aiyagari MD

Authors
  1. John R. Charpie MD, PhD
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  2. Dennis C. Crowley MD
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  3. Ranjit Aiyagari MD
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Corresponding author

Correspondence to John R. Charpie MD, PhD .

Editor information

Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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© 2014 Springer-Verlag London

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Charpie, J.R., Crowley, D.C., Aiyagari, R. (2014). Congenital Heart Disease: Left Ventricular Outflow Tract Obstruction. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6356-5_23

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  • DOI: https://doi.org/10.1007/978-1-4471-6356-5_23

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6355-8

  • Online ISBN: 978-1-4471-6356-5

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