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Left ventricular outflow tract obstruction

MedGen UID:
6031
Concept ID:
C0023213
Disease or Syndrome
Synonyms: Left Ventricular Outflow Obstruction; Left Ventricular Outflow Tract Obstruction; LVOT Obstruction; LVOT Obstructions; Obstruction, LVOT; Outflow Obstruction, Left Ventricular; Ventricular Outflow Obstruction, Left
SNOMED CT: LVOTO - Left ventricular outflow tract obstruction (253546004); Left ventricular outflow tract obstruction (253546004)
 
HPO: HP:0032092

Definition

Left ventricular outflow tract (LVOT) obstruction can occur at the valvular, subvalvular, or supravalvular level. In general, there is an obstruction to forward flow which increases afterload, and if untreated, can result in hypertrophy, dilatation, and eventual failure of the left ventricle. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVLeft ventricular outflow tract obstruction

Conditions with this feature

Hypertrophic cardiomyopathy 15
MedGen UID:
413312
Concept ID:
C2750459
Disease or Syndrome
Any hypertrophic cardiomyopathy in which the cause of the disease is a mutation in the VCL gene.
Hypertrophic cardiomyopathy 14
MedGen UID:
442484
Concept ID:
C2750467
Disease or Syndrome
An autosomal dominant subtype of familial hypertrophic cardiomyopathy caused by mutation(s) in the MYH6 gene, encoding myosin-6.
Congenital heart defects, multiple types, 6
MedGen UID:
462571
Concept ID:
C3151221
Congenital Abnormality
Multiple types of congenital heart defects are associated with mutation in the GDF1 gene, including tetralogy of fallot (TOF), transposition of the great arteries (TGA), double-outlet right ventricle (DORV), total anomalous pulmonary venous return (TAPVR), pulmonary stenosis or atresia, atrioventricular canal, ventricular septal defect (VSD), and hypoplastic left or right ventricle (Jin et al., 2017). For a discussion of genetic heterogeneity of multiple types of congenital heart defects, see 306955.
Congenital heart defects, multiple types, 2
MedGen UID:
767193
Concept ID:
C3554279
Disease or Syndrome
Multiple types of congenital heart defects-2 (CHTD2) is characterized by variable congenital heart defects, primarily involving the valves, but also including septal defects or aneurysms, and complex defects such as tetralogy of Fallot. Dilated cardiomyopathy and myocardial noncompaction have been reported in some patients. In addition, some affected individuals exhibit facial dysmorphism and features of connective tissue disease (Thienpont et al., 2010; Ackerman et al., 2016; Ritelli et al., 2018). For a discussion of genetic heterogeneity of CHTD, see 306955.
Congenital heart defects, multiple types, 4
MedGen UID:
862747
Concept ID:
C4014310
Disease or Syndrome
The multiple types of congenital heart defects observed in CHTD4 include atrial, ventricular, and atrioventricular septal defects, double-outlet right ventricle, tetralogy of Fallot, hypoplastic left heart syndrome, aortic stenosis, and coarctation of the aorta. Intrafamilial variability and incomplete penetrance has been reported (Al Turki et al., 2014; Qiao et al., 2018). Some patients exhibit syndromic features such as developmental delay, congenital diaphragmatic hernia, and severe gastroesophageal reflux (High et al., 2016; Upadia et al., 2018). For a discussion of genetic heterogeneity of multiple types of congenital heart defects, see CHTD1 (306955).
Cardiomyopathy, familial hypertrophic, 28
MedGen UID:
1779612
Concept ID:
C5543616
Disease or Syndrome
Familial hypertrophic cardiomyopathy-28 (CMH28) is characterized by asymmetric septal hypertrophy, atrial fibrillation and nonsustained ventricular tachycardia, and risk of sudden death. Dyspnea is the most common symptom, but more than half of affected individuals are asymptomatic. Hypertrabeculation of the left ventricle with noncompaction has been observed in some patients (Ochoa et al., 2018). For a general phenotypic description and discussion of genetic heterogeneity of familial hypertrophic cardiomyopathy, see CMH1 (192600).
Cardiomyopathy, familial hypertrophic, 29, with polyglucosan bodies
MedGen UID:
1824081
Concept ID:
C5774308
Disease or Syndrome
Hypertrophic cardiomyopathy-29 (CMH29) is characterized by recurrent syncope, dyspnea on exertion, and palpitations. The clinical phenotype is associated with a poor prognosis due to lethal arrhythmias and cardiac failure. Cardiac muscle biopsies show intermyofibrillar accumulation of glycogen and polyglucosan bodies within cardiomyocytes, and skeletal muscle accumulation of glycogen has also been observed (Hedberg-Oldfors et al., 2019). For a general phenotypic description and discussion of genetic heterogeneity of hypertrophic cardiomyopathy, see CMH1 (192600).

Professional guidelines

PubMed

Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e533-e557. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000938. PMID: 33215938
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e558-e631. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000937. PMID: 33215931
Authors/Task Force members, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H
Eur Heart J 2014 Oct 14;35(39):2733-79. Epub 2014 Aug 29 doi: 10.1093/eurheartj/ehu284. PMID: 25173338

Recent clinical studies

Etiology

Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB
Circulation 2024 Jun 4;149(23):e1239-e1311. Epub 2024 May 8 doi: 10.1161/CIR.0000000000001250. PMID: 38718139
Abbasi M, Ong KC, Newman DB, Dearani JA, Schaff HV, Geske JB
J Am Soc Echocardiogr 2024 Jun;37(6):613-625. Epub 2024 Feb 28 doi: 10.1016/j.echo.2024.02.010. PMID: 38428652
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e533-e557. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000938. PMID: 33215938
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e558-e631. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000937. PMID: 33215931
Zhang L, Piña IL
Heart Fail Clin 2019 Jan;15(1):41-53. doi: 10.1016/j.hfc.2018.08.005. PMID: 30449379

Diagnosis

Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB
Circulation 2024 Jun 4;149(23):e1239-e1311. Epub 2024 May 8 doi: 10.1161/CIR.0000000000001250. PMID: 38718139
Abbasi M, Ong KC, Newman DB, Dearani JA, Schaff HV, Geske JB
J Am Soc Echocardiogr 2024 Jun;37(6):613-625. Epub 2024 Feb 28 doi: 10.1016/j.echo.2024.02.010. PMID: 38428652
Braunwald E, Saberi S, Abraham TP, Elliott PM, Olivotto I
Eur Heart J 2023 Nov 21;44(44):4622-4633. doi: 10.1093/eurheartj/ehad637. PMID: 37804245Free PMC Article
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e533-e557. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000938. PMID: 33215938
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e558-e631. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000937. PMID: 33215931

Therapy

Maron MS, Masri A, Nassif ME, Barriales-Villa R, Arad M, Cardim N, Choudhury L, Claggett B, Coats CJ, Düngen HD, Garcia-Pavia P, Hagège AA, Januzzi JL, Lee MMY, Lewis GD, Ma CS, Michels M, Olivotto I, Oreziak A, Owens AT, Spertus JA, Solomon SD, Tfelt-Hansen J, van Sinttruije M, Veselka J, Watkins H, Jacoby DL, Heitner SB, Kupfer S, Malik FI, Meng L, Wohltman A, Abraham TP; SEQUOIA-HCM Investigators
N Engl J Med 2024 May 30;390(20):1849-1861. Epub 2024 May 13 doi: 10.1056/NEJMoa2401424. PMID: 38739079
Braunwald E, Saberi S, Abraham TP, Elliott PM, Olivotto I
Eur Heart J 2023 Nov 21;44(44):4622-4633. doi: 10.1093/eurheartj/ehad637. PMID: 37804245Free PMC Article
Dybro AM, Rasmussen TB, Nielsen RR, Andersen MJ, Jensen MK, Poulsen SH
J Am Coll Cardiol 2021 Dec 21;78(25):2505-2517. doi: 10.1016/j.jacc.2021.07.065. PMID: 34915981
Liu Y, Chen S, Zühlke L, Black GC, Choy MK, Li N, Keavney BD
Int J Epidemiol 2019 Apr 1;48(2):455-463. doi: 10.1093/ije/dyz009. PMID: 30783674Free PMC Article
Santos Mateo JJ, Sabater Molina M, Gimeno Blanes JR
Med Clin (Barc) 2018 Jun 8;150(11):434-442. Epub 2017 Nov 14 doi: 10.1016/j.medcli.2017.09.013. PMID: 29150126

Prognosis

Abbasi M, Ong KC, Newman DB, Dearani JA, Schaff HV, Geske JB
J Am Soc Echocardiogr 2024 Jun;37(6):613-625. Epub 2024 Feb 28 doi: 10.1016/j.echo.2024.02.010. PMID: 38428652
Lioncino M, Monda E, Verrillo F, Moscarella E, Calcagni G, Drago F, Marino B, Digilio MC, Putotto C, Calabrò P, Russo MG, Roberts AE, Gelb BD, Tartaglia M, Limongelli G
Heart Fail Clin 2022 Jan;18(1):19-29. Epub 2021 Oct 25 doi: 10.1016/j.hfc.2021.07.004. PMID: 34776080Free PMC Article
Grayburn PA, Thomas JD
JACC Cardiovasc Imaging 2021 Apr;14(4):843-853. Epub 2021 Jan 13 doi: 10.1016/j.jcmg.2020.06.049. PMID: 33454273
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e558-e631. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000937. PMID: 33215931
Marian AJ, Braunwald E
Circ Res 2017 Sep 15;121(7):749-770. doi: 10.1161/CIRCRESAHA.117.311059. PMID: 28912181Free PMC Article

Clinical prediction guides

Maron MS, Masri A, Nassif ME, Barriales-Villa R, Arad M, Cardim N, Choudhury L, Claggett B, Coats CJ, Düngen HD, Garcia-Pavia P, Hagège AA, Januzzi JL, Lee MMY, Lewis GD, Ma CS, Michels M, Olivotto I, Oreziak A, Owens AT, Spertus JA, Solomon SD, Tfelt-Hansen J, van Sinttruije M, Veselka J, Watkins H, Jacoby DL, Heitner SB, Kupfer S, Malik FI, Meng L, Wohltman A, Abraham TP; SEQUOIA-HCM Investigators
N Engl J Med 2024 May 30;390(20):1849-1861. Epub 2024 May 13 doi: 10.1056/NEJMoa2401424. PMID: 38739079
Grayburn PA, Thomas JD
JACC Cardiovasc Imaging 2021 Apr;14(4):843-853. Epub 2021 Jan 13 doi: 10.1016/j.jcmg.2020.06.049. PMID: 33454273
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e533-e557. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000938. PMID: 33215938
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P
Circulation 2020 Dec 22;142(25):e558-e631. Epub 2020 Nov 20 doi: 10.1161/CIR.0000000000000937. PMID: 33215931
Marian AJ, Braunwald E
Circ Res 2017 Sep 15;121(7):749-770. doi: 10.1161/CIRCRESAHA.117.311059. PMID: 28912181Free PMC Article

Recent systematic reviews

Sawan MA, Prabakaran S, D'Souza M, Behbahani-Nejad O, Gold ME, Williams BR, Bilen O
Clin Cardiol 2024 Jan;47(1):e24207. doi: 10.1002/clc.24207. PMID: 38269637Free PMC Article
Bayonas-Ruiz A, Muñoz-Franco FM, Sabater-Molina M, Oliva-Sandoval MJ, Gimeno JR, Bonacasa B
ESC Heart Fail 2023 Feb;10(1):8-23. Epub 2022 Oct 1 doi: 10.1002/ehf2.14142. PMID: 36181355Free PMC Article
Li S, Wang Q, Luo W, Jia S, Liu D, Ma W, Gu H, Wei X, He Y, Cao S, Yuan Z
Environ Sci Pollut Res Int 2022 Aug;29(37):55348-55366. Epub 2022 Jun 6 doi: 10.1007/s11356-022-21071-7. PMID: 35668266
Liu Y, Chen S, Zühlke L, Black GC, Choy MK, Li N, Keavney BD
Int J Epidemiol 2019 Apr 1;48(2):455-463. doi: 10.1093/ije/dyz009. PMID: 30783674Free PMC Article
Collis RA, Rahman MS, Watkinson O, Guttmann OP, O'Mahony C, Elliott PM
Int J Cardiol 2018 Aug 15;265:62-70. doi: 10.1016/j.ijcard.2018.01.130. PMID: 29885701

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