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Left ventricular outflow tract obstruction (LVOTO) refers to the obstruction of the blood flowing out of the left ventricle. It 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. Patients presenting with signs and symptoms of LVOTO may see a pediatrician or general physician first and then be referred to an adult or pediatric cardiologist. While traditionally defined in patients with hypertrophic cardiomyopathy, LVOTO is known to have several causes. This activity describes the evaluation of patients with LVOTO and highlights the interprofessional team's role in managing patients with this condition. Objectives: Determine the clinical signs and symptoms of left ventricular outflow tract obstruction (LVOTO) patients. Identify the diagnostic modalities for evaluating LVOTO and the diagnostic findings on clinical imaging. Apply the management plan for patients with LVOTO. Communicate the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected with LVOTO. Access free multiple choice questions on this topic.

Left ventricular outflow tract obstruction (LVOTO) limits blood flow from the left ventricle. The level of obstruction can be valvular, sub-valvular, or supravalvular. It can include anatomic stenotic lesions anywhere from left ventricle (LV) outflow to descending aorta. Hemodynamically, LVOTO has been defined as a peak instantaneous gradient at LV outflow of at least 30 mmHg, either at rest or on provocation.[1] While traditionally defined in patients with hypertrophic cardiomyopathy, LVOTO is known to have several causes. LVOTO constitutes 6% of congenital heart diseases, and in most cases, the cause of LVOTO is congenital.[2] It can occur in isolation or accompany other congenital heart diseases.[3] Dynamic LVOTO can also be seen in critically ill patients, whereby the use of inotropes in patients with intravascular volume depletion results in hypovolemia.[4] 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.

There are many causes of left ventricular outflow tract obstruction (LVOTO). Thus, the condition is best managed by an interprofessional team that includes a pediatrician, cardiologist, cardiac sonographer, cardiac surgeon, internist, and cardiac nurses. Most cases of LVOTO in newborns and children are congenital, whereas, in adults, the cause may be a bicuspid aortic valve or degenerative aortic stenosis. In almost all cases, symptomatic patients need surgery because the obstruction is mechanical. The outcome depends on the patient's age, comorbid condition, and severity of the heart disease. The entire healthcare team must communicate openly with all team members to promptly address any concerns. This includes meticulous record keeping and ensuring that anyone on the interprofessional team who examines the patient record has the most updated and accurate information on which to base clinical decisions. Nurses are also crucial in monitoring the patient's condition and coordinating with the appropriate specialists, particularly if the patient's condition deteriorates. This interprofessional approach will be the best method to achieve optimal patient outcomes.

For patients presenting with signs and symptoms of dyspnea, syncope, or a clinical examination that reveals a systolic murmur, further evaluation with transthoracic echocardiography is necessary. Healthcare team members should know the importance of timely referral in this disease entity. A cardiologist, a cardiovascular nurse specialist, a cardiac surgeon, a pediatric cardiologist, and a sports specialist should work together to devise activity limitations for these patients until a definite surgical correction is performed.