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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.
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).

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

Nagueh SF, Phelan D, Abraham T, Armour A, Desai MY, Dragulescu A, Gilliland Y, Lester SJ, Maldonado Y, Mohiddin S, Nieman K, Sperry BW, Woo A
J Am Soc Echocardiogr 2022 Jun;35(6):533-569. doi: 10.1016/j.echo.2022.03.012. PMID: 35659037
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
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

Diagnosis

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):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

Therapy

Zhou M, Ta S, Hahn RT, Hsi DH, Leon MB, Hu R, Zhang J, Zuo L, Li J, Wang J, Wang B, Zhu X, Liu J, Han Y, Li X, Xu B, Zhang L, Hou L, Han C, Liu J, Liu L
JAMA Cardiol 2022 May 1;7(5):529-538. doi: 10.1001/jamacardio.2022.0259. PMID: 35353129Free 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
Zampieri M, Argirò A, Marchi A, Berteotti M, Targetti M, Fornaro A, Tomberli A, Stefàno P, Marchionni N, Olivotto I
Curr Cardiol Rep 2021 Jun 3;23(7):79. doi: 10.1007/s11886-021-01508-0. PMID: 34081217
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
Nishimura RA, Seggewiss H, Schaff HV
Circ Res 2017 Sep 15;121(7):771-783. doi: 10.1161/CIRCRESAHA.116.309348. PMID: 28912182

Prognosis

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):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

Clinical prediction guides

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
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

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
Ben-Ali W, Ibrahim R, Rodès-Cabeau J, von Bardeleben RS, Mylotte D, Granada J, Modine T
Curr Cardiol Rep 2021 Mar 9;23(4):37. doi: 10.1007/s11886-021-01466-7. PMID: 33687594
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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