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Left Ventricular Outflow Tract Obstruction

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Critical Care of Children with Heart Disease

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Abstract

Left ventricular outflow tract obstruction (LVOTO) accounts for 3.5–10% of all congenital heart defects [1, 2], with the majority of patients being male. LVOTO occurs at the valvar (70%), subvalvar (14%), and supravalvar (8%) levels, and several levels of obstruction often coexist (8%) [3]. LVOTO may be further compounded by other left-sided anomalies (small left atrium, abnormal mitral valve, small – or even hypoplastic – left ventricle (LV), aortic coarctation (CoA), or interrupted aortic arch) [4]. Often seen in this context is Shone’s complex – a combination of a parachute mitral valve, supra-annular mitral ring, subaortic stenosis, and CoA [5]. Ventricular septal defects, abnormal attachments of the mitral or tricuspid valve apparatus, and pulmonary venous anomalies may coexist with LVOTO. Critical LVOTO presents as shock in the early neonatal period, while less severe defects may only become clinically significant later in childhood, or even remain silent into adulthood [6].

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Author information

Authors and Affiliations

  1. Division of Critical Care Medicine, Department of Pediatrics, Advocate Lutheran General Children’s Hospital, Park Ridge, IL, USA

    Michael D. Tsifansky

  2. Chief, Division of Cardiac Critical Care Medicine Executive Director, Telemedicine Co-director, Children’s National Heart Institute Professor of Pediatrics, George Washington University School of Medicine Children’s National Health System, Washington, DC, USA

    Ricardo A. Munoz

  3. Department of Pediatric Cardiothoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Victor O. Morell

Authors
  1. Michael D. Tsifansky
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  2. Ricardo A. Munoz
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  3. Victor O. Morell
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Corresponding author

Correspondence to Michael D. Tsifansky .

Editor information

Editors and Affiliations

  1. Chief, Division of Cardiac Critical Care Medicine Executive Director, Telemedicine Co-director, Children’s National Heart Institute, Professor of Pediatrics, George Washington University School of Medicine, Children’s National Health System, Washington, DC, USA

    Ricardo A. Munoz

  2. Department of Pediatric Cardiothoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Victor O. Morell

  3. Associate Medical Director, CHCO Heart Institute Head, Pediatric Cardiac Critical Care Program & Inpatient Services Director, Cardiac Intensive Care Unit Children’s Hospital Colorado, Tenured Professor of Pediatrics, Pediatric Cardiology and Intensive Care University of Colorado Denver, School of Medicine, Aurora, CO, USA

    Eduardo M. da Cruz

  4. Department of Pharmacy, Pediatric Critical Care, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Carol G. Vetterly

  5. Department of Pediatric Cardiothoracic Surgery, UPMC – Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Jose Pedro da Silva

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Tsifansky, M.D., Munoz, R.A., Morell, V.O. (2020). Left Ventricular Outflow Tract Obstruction. In: Munoz, R., Morell, V., da Cruz, E., Vetterly, C., da Silva, J. (eds) Critical Care of Children with Heart Disease . Springer, Cham. https://doi.org/10.1007/978-3-030-21870-6_23

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  • DOI: https://doi.org/10.1007/978-3-030-21870-6_23

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