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PubMedDate not supplied

Sites of right ventricular outflow tract obstruction in tetralogy of Fallot--a retrospective study.

Fifty one angiographically proved cases of tetralogy of Fallot (TOF) in the age group of 5-50 years were analysed retrospectively for the level(s) of right ventricular outflow tract (RVOT) obstruction. Mean age was 18.1 +/- 11 yrs. Subvalvular stenosis was found to be the commonest site of RVOT obstruction in 49 (96.1%) patients. Evidence of valvular pulmonary stenosis was seen quite commonly (42/51, 83.9% cases), mostly in association with obstruction at other sites. Supravalvular stenosis was also seen in 17 (33.3%) cases. Higher incidence of pulmonary valvular involvement in patients with TOF, in higher average age of patient population may represent valvular involvement to be an acquired phenomenon.

Adolescent↗
PubMed2005

Pedicled cardiac hemangioma with right ventricular outflow tract obstruction.

A 46-year-old female was admitted to our hospital complaining of dizziness. Echocardiography and magnetic resonance imaging showed a pedicled tumor in the right ventricular outflow tract (RVOT), causing severe obstruction during systole. Resection was performed under cardiopulmonary bypass. Postoperative course was uneventful, with complete disappearance of major symptoms. Histological examination revealed the nature of the tumor to be a benign hemangioma. As reports of cardiac hemangioma causing severe RVOT obstruction are extremely rare, this case warrants attention.

Female↗
PubMed2001

Differential diagnosis of intracavitary tumors obstructing the right ventricular outflow tract.

Three cases of right ventricular outflow tract obstruction caused by 3 distinct tumors-myxoma, sarcoma, and presumed metastatic tumor-diagnosed by transthoracic and transesophageal echocardiography are presented. The differences among these 3 types of tumors with similar clinical and echocardiographic findings are highlighted, and a review of the pertinent literature is discussed. By applying the approximate frequencies of cardiac tumors categorized by type and site, statistically, an intracavitary right ventricular outflow tract tumor is 70 to 140 times more likely to be malignant than benign; furthermore, if it is a primary cardiac tumor, it is approximately 2 times more likely to be a sarcoma than a myxoma.

Aged↗
PubMed1987

Benign congenital intracardiac thyroid and polycystic tumor causing right ventricular outflow tract obstruction and conduction disturbance.

A patient with a rare intracardiac tumor arising from the right side of the interventricular septum who developed conduction disturbances and symptoms of right ventricular outflow tract obstruction is reported. The patient was successfully treated with insertion of a permanent pacemaker and surgical removal of the tumor after two-dimensional echocardiography diagnosed the intracardiac mass. Pathologic examination confirmed the benign nature of the tumor and showed the unusual features of both ectopic thyroid and benign congenital polycystic tumor.

Choristoma↗
PubMed1989

Right ventricular outflow tract obstruction due to extracardiac tumors. A report of three cases diagnosed and followed up by echocardiographic studies.

Echocardiography has become a valuable diagnostic tool in various clinical conditions. Its use for the detection of extracardiac tumors has seldom been reported. The majority of these descriptions are of single case reports. We have recently encountered three patients (two with lymphomas and one with seminoma) who presented with signs and symptoms suggestive of right ventricular outflow tract obstruction. Two-dimensional echocardiography enabled the prompt diagnosis of extracardiac tumors compressing the heart. Moreover, echocardiography proved to be an excellent noninvasive tool for assessing the success of therapy for mediastinal tumors.

Adult↗
PubMed1977

[A new surgical technique for treatments of left ventricular outflow tract obstructions. Report of a case and reexamination of our experience (author's transl)].

Aortic valvotomy, aortic valve replacement, resection of the subaortic membrane and aortic patch angioplasty do not always provide satisfactory relief of left ventricular outflow tract obstruction. From August 1975 through January 1977, 15 patients underwent creation of a left ventricular vent by means of a Dacron fabric conduit containing a heterograft valve going from the left ventricle to the supraceliac portion of the abdominal aorta (Cooley's point). All patients had valvular, subvalvular, supravalvular aortic stenosis, or combined defects. One patient had severe hemolytic anemia following aortic valve replacement. Eleven of our 15 patients had undergone one or more previous surgical procedures for relief of aortic stenosis. The operative mortality has been one patient. At postoperative catheterization, there was a normalization of pressure gradients, and the blood flow through the conduit was 40% of the cardiac output. An interesting case of supravalvular aortic stenosis associated with stenosis of the vessels of the arch is presented.

Adolescent↗
PubMed1976

Late results of surgery for left ventricular outflow tract obstruction in children.

Forty-four patients, with a mean age at surgery of 10 years, were followed for 5 to 16 years (mean 9.7 years) after relief of left ventricular outflow tract obstruction. There were no early deaths, but 5 late deaths occurred, 3 following reoperation. Twenty-five patients were recatheterized from 1 to 16 years later (mean 6.6 years). In 21 of 32 patients (66 per cent), a new diastolic murmur followed relief of valvular stenosis; 25 (78 per cent) of these patients had a postoperative diastolic murmur. Seventeen of these 25 (68 per cent) were recatheterized, and 11 of the 17 (65 per cent) had moderate-to-severe aortic incompetence on angiography. Eight patients (18 per cent) have undergone reoperation and 9 more (20 per cent) will have to be reoperated upon soon. Although the aortic valve gradient and left ventricular stroke pressure were reduced in all obstructive types after surgery, left ventricular end-diastolic pressure significantly increased and cardiac index decreased after valvotomy. Cardiomegaly and electrocardiographic (ECG) abnormalities were present in 45 and 66 per cent, respectively, of all postoperative patients. Although 93 per cent of patients may be expected to survive and 82 per cent be reoperation free at 10 years, further surgery thereafter becomes increasingly common. Timely relief of obstruction prevents sudden death and produces excellent symptomatic improvement, but the operation is only palliative. Development of a reliable pediatric valve and ventriculo-aortic conduit may encourage earlier and more aggressive therapy.

Abnormalities, Multiple↗
PubMed1997

Dynamic Left Ventricular Outflow Tract Obstruction During Myocardial Ischemia in Mitral Valve Prolapse Syndrome.

Systolic anterior motion of the mitral valve (MV) with dynamic left ventricular (LV) outflow tract obstruction is a well known phenomenon in hypertrophic cardiomyopathy, or other forms of hyperdynamic LV function associated with hypovolemic states, or LV hypertrophy. We report three patients with MV prolapse in the absence of the above predisposing factors, who developed an LV outflow dynamic gradient during acute transient myocardial ischemia. An interaction between structural abnormalities of the mitral apparatus and ischemia-dependent LV shape deformity most likely accounted for the outflow gradient.

Journal Article↗
PubMed2000

Transesophageal echocardiographic (TEE) evaluation of the aortic valve, left ventricular outflow tract, and pulmonic valve.

The most important role of TEE in aortic valve disease is in the diagnosis of endocarditis and its complications. Examination of the annulus and subvalvular region is essential in any patient with possible aortic valve endocarditis. Assessment of the severity of aortic stenosis is a useful application of TEE when other data are either inconsistent or unavailable. TEE can provide a diagnosis of the origin of acute severe aortic insufficiency; this information may play a critical role in surgical planning. The diagnosis of a variety of aortic valve diseases can be made when TEE is performed to find an embolic source or to rule out dissection. In the case of mass lesions, such as papillary fibroelastomas and Libman-Sacks vegetations, the results of TEE carry major therapeutic implications. TEE offers generally excellent quality images of the LVOT and images of the RVOT and pulmonic valve that are superior to transthoracic echocardiography. The major clinical usefulness of TEE stems from its ability to identify pulmonic valve mass lesions and the causes of left and right ventricular outflow obstruction. TEE is also an important adjunct in the surgical management of left ventricular outflow obstruction.

Aortic Valve↗
PubMed2006

Increased mitral regurgitation during the valsalva maneuver in a patient with pheochromocytoma, uncontrolled hypertension, cardiac hypertrophy, and dynamic outflow tract obstruction.

Dynamic left ventricular outflow tract obstruction is a common feature of hypertrophic cardiomyopathy, but it can also be demonstrated in other conditions that result in increased thickness of the left ventricular septal wall. Severe uncontrolled hypertension may lead to severe hypertrophy of the left ventricle and produce systolic anterior motion of the mitral valve and an outflow gradient. We report a case of pheochromocytoma with echocardiographic demonstration of markedly increased mitral regurgitation during the Valsalva maneuver in a patient with left ventricular hypertrophy and a dynamic outflow tract obstruction.

Adrenal Gland Neoplasms↗
PubMed2003

[Reoperation for double-outlet right ventricle (SDL type) following the Rastelli procedure: report of a case].

The relationship of the conduit to the sternum is crucial in the Rastelli operation. Right-sided conduits are more greatly affected by sternal compression than left, since the position of the right ventricular infundibulum is more anterior. A 37-year-old woman developed right ventricular outflow tract obstruction, left ventricular outflow tract obstruction, and aortic valve regurgitation secondary to infective endocarditis 15 years after Rastelli repair for double-outlet right ventricle (SDL). We enlarged the ventricular septal defect, performed intraventricular rerouting and aortic valve replacement, and reconstructed the valved conduit using a Carpentier-Edwards conduit. The old conduit was densely adherent to the sternum. Subaortic stenosis was caused by a narrow fibromuscular ridge associated with a bulge of the underlying septal muscle. The patient's recovery was uneventful. She is alive and well without any complaints 1 year after surgery.

Adult↗
PubMed2005

Effects of pulmonary valve replacement on QRS duration and right ventricular cavity size late after repair of right ventricular outflow tract obstruction.

This study evaluated the effects of pulmonary valve replacement (PVR) on QRS duration and right ventricular (RV) cavity size in patients who had severe pulmonary regurgitation late after previous repair of RV outflow tract obstruction. A significant decrease in maximal QRS duration and RV end-diastolic volume was found after PVR. The change in QRS duration was most significant in patients with a baseline QRS > or =155 ms (176 +/- 15 to 160 +/- 18 ms, p <0.001). RV end-diastolic volume was significantly correlated with maximal QRS duration before (r = 0.93, p <0.0001) as well as after (r = 0.82, p <0.001) PVR. In patients with pulmonary regurgitation late after repair of RV outflow tract obstruction, PVR reduces maximal QRS duration with a concomitant decrease in RV volumes.

Adult↗