Left Ventricular Outflow Obstruction

Occlusion of the outflow tract in the LEFT VENTRICLE of the heart.

Also Known As:

Ventricular Outflow Obstruction, Left; Outflow Obstruction, Left Ventricular; Dynamic LVOT Obstructions; LVOT Obstruction, Dynamic; LVOT Obstructions; Obstruction, Dynamic LVOT; Obstruction, LVOT; Dynamic LVOT Obstruction; Dynamic Left Ventricular Outflow Tract Obstruction; LVOT Obstruction; Left Ventricular Outflow Tract Obstruction

Networked: 596 relevant articles (35 outcomes, 44 trials/studies)

Relationship Network

Disease Context: Research Results

Cardiovascular Diseases: 91362
- Heart Diseases: 26014
  - Ventricular Outflow Obstruction: 8
    - Left Ventricular Outflow Obstruction: 596

Related Diseases

1.	Hypertrophic Cardiomyopathy (Hypertrophic Obstructive Cardiomyopathy)
2.	Syncope (Fainting)
3.	Hypertrophy
4.	Heart Failure
5.	Atrial Fibrillation

Experts

1.	Olivotto, Iacopo: 8 articles (01/2022 - 08/2006)
2.	Schaff, Hartzell V: 8 articles (08/2021 - 12/2004)
3.	Ommen, Steve R: 8 articles (11/2016 - 12/2004)
4.	Smedira, Nicholas G: 7 articles (01/2022 - 12/2004)
5.	Nishimura, Rick A: 7 articles (11/2016 - 12/2004)
6.	Maron, Martin S: 6 articles (01/2022 - 08/2006)
7.	Dearani, Joseph A: 6 articles (08/2021 - 12/2004)
8.	Sorajja, Paul: 6 articles (01/2019 - 07/2008)
9.	Desai, Milind Y: 5 articles (01/2022 - 07/2013)
10.	Jacoby, Daniel: 5 articles (01/2022 - 06/2014)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Left Ventricular Outflow Obstruction:

1.	MYK-461IBA 10/01/2022 - "A sarcomere modulator - mavacamten - has been shown to improve exercise capacity, left ventricular outflow tract obstruction, New York Heart Association functional class and health status in a phase 3 trial. " 01/01/2021 - "Following a successful Phase 2 study, the recently published phase III, placebo-controlled, randomized EXPLORER-HCM trial demonstrated the efficacy and safety of mavacamten in reducing left ventricular outflow tract obstruction and ameliorating exercise capacity, New York Heart Association functional class and health status in patients with obstructive HCM. " 01/01/2019 - "Mavacamten can reduce LVOT obstruction and improve exercise capacity and symptoms in patients with oHCM. " 01/01/2016 - "Our findings provide proof of principle that acute reduction in contractility with MYK-461 is sufficient to relieve LVOT obstruction. " 01/01/2016 - "Here, we use MYK-461 to test whether direct reduction in contractility is sufficient to relieve LVOT obstruction in feline HCM. "
2.	Biomarkers (Surrogate Marker)IBA 11/01/2022 - "Elevated biomarkers seem to depict patients with more severe disease, adding diagnostic and prognostic information to conventional assessments, such as left ventricular ejection fraction, New York Heart Association class and left ventricular outflow tract obstruction. " 12/28/2021 - "We hypothesized that metabolomic biomarkers for LVOT obstruction may be detectable in plasma from HCM patients. " 12/28/2021 - "To date, no reliable biomarkers for LVOT obstruction exist. " 03/20/2019 - "Associations Between Multiple Circulating Biomarkers and the Presence of Atrial Fibrillation in Hypertrophic Cardiomyopathy with or Without Left Ventricular Outflow Tract Obstruction." 01/01/2023 - "Mavacamten improved measures of functional capacity, left ventricular outflow tract obstruction, symptom burden and biomarkers in patients with HCM regardless of beta-blocker use. "
3.	Phenylephrine (Neo-Synephrine)FDA LinkGeneric 12/01/2013 - "In addition, landiolol, phenylephrine, and low-dose dopamine were administered to prevent left ventricular outflow tract obstruction, and were found to be effective for improving acute hemodynamic changes during surgery. " 03/01/2006 - "Propranolol, phenylephrine infusion, and saline volume loading were similarly effective in reversing dobutamine-induced LVOT obstruction in this canine model of ACS. " 03/01/2006 - "The purpose of the present study was to compare the utility of propranolol, phenylephrine infusion, and rapid saline loading for reversal of dobutamine-induced LVOT obstruction in a canine model of ACS. " 03/01/2006 - "Different effects of propranolol, phenylephrine, and saline volume loading on catecholamine-induced left ventricular outflow tract obstruction in acute coronary syndrome."
4.	Disopyramide (Norpace)FDA LinkGeneric 06/01/2020 - "Disopyramide might relieve feline LVOT obstruction after only partial response to a beta-blocker. " 02/01/2002 - "An intraoperative diagnosis of dynamic left ventricular outflow tract obstruction using transesophageal echocardiography leads to the treatment with intravenous disopyramide." 04/01/2018 - "Disopyramide was effective for the relief of left ventricular outflow tract obstruction in children with hypertrophic cardiomyopathy, although longer-term data suggest that its efficacy is not sustained. " 04/06/2023 - "Background: Although disopyramide has been widely used to reduce left ventricular outflow obstruction (LVOTO) and to improve symptoms in patients with obstructive hypertrophic cardiomyopathy (oHCM), its use in real world as well as patient characteristics associated with a positive treatment response are still unclear. " 03/01/1991 - "Two children with left ventricular outflow tract obstruction due to myocardial hypertrophy received oral disopyramide as a negative inotrope. "
5.	landiololIBA 01/01/2006 - "[Case in which landiolol hydrochloride improved left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve following mitral valve plasty]." 04/01/2020 - "Landiolol, the ultrashort-acting beta-blocker, may be a promising therapeutic option for rapid recovery of increased PG due to LVOT obstruction." 03/01/2019 - "In this case, the dose of landiolol hydrochloride was increased to 10 μg/kg/min, resulting in improvement of LVOT obstruction, which led to hemodynamic stabilization." 03/01/2019 - "Herein, we describe a 72-year-old woman in whom landiolol hydrochloride was used in the acute phase of TTS with LVOT obstruction. " 01/01/2006 - "TEE was a much useful tool for early diagnosis and landiolol hydrochloride would be a notable agent for nonsurgical treatment of LVOT obstruction with SAM."
6.	Cardiac MyosinsIBA 01/01/2023 - "Over the past decade, improved understanding of the molecular pathobiology of HCM has culminated in development of cardiac myosin inhibitors (CMIs), a novel drug class that in recent randomized clinical trials has been shown to decrease LVOT obstruction, improve exercise capacity, and ameliorate symptom burden in patients with oHCM. " 01/01/2023 - "The purpose of this study was to characterize the pharmacodynamic effects of a single oral dose of the novel cardiac myosin inhibitor aficamten (CK-274) on cardiac function in purpose bred cats with naturally occurring A31P MYBPC3 mutation and a clinical diagnosis of HCM with left ventricular outflow tract obstruction (LVOTO). " 09/01/2023 - "Mavacamten and aficamten, selective modulators of cardiac myosin, have demonstrated encouraging results in clinical trials by reducing left ventricular outflow tract obstruction and improving symptoms in patients with obstructive HCM. " 01/01/2021 - "EXPLORER-HCM was a phase 3, randomized, double-blind, placebo-controlled, multicenter clinical trial investigating the effects of mavacamten, a first-in-class selective cardiac myosin inhibitor, in patients with HCM, left ventricular outflow tract obstruction (LVOTO) and New York Heart Association (NYHA) class II or III symptoms. " 09/01/2023 - "Cardiac myosin stimulator, omecamtiv mecarbil, has shown efficacy in HFrEF, lowering HF related events or cardiovascular death, while the 2 inhibitors, mavacamten and aficamten have been shown to reduce hypercontractility and left ventricular outflow obstruction improving functional capacity in randomized trials targeting hypertrophic cardiomyopathy. "
7.	omecamtiv mecarbilIBA 12/16/2020 - "Omecamtiv Mecarbil showed limited efficacy in phase III GALACTIC-HF trial, while, results from phase III EXPLORER-HCM trial were recently published, indicating that Mavacamten reduced left ventricular outflow tract (LVOT) obstruction and diastolic dysfunction and improved the health status of patients with HCM. " 09/01/2023 - "Cardiac myosin stimulator, omecamtiv mecarbil, has shown efficacy in HFrEF, lowering HF related events or cardiovascular death, while the 2 inhibitors, mavacamten and aficamten have been shown to reduce hypercontractility and left ventricular outflow obstruction improving functional capacity in randomized trials targeting hypertrophic cardiomyopathy. " 01/01/2022 - "In cardiac patients, a cardiac myosin stimulator, omecamtiv mecarbil, has shown efficacy in heart failure with reduced systolic function, lowering heart failure related events or cardiovascular death, while two inhibitors, mavacamten and aficamten, in randomized trials targeting hypertrophic cardiomyopathy, have been shown to reduce hypercontractility and left ventricular outflow obstruction improving functional capacity. "
8.	Dobutamine FDA LinkGeneric 08/20/2018 - "Transthoracic echocardiography showed a sigmoid septum; dobutamine-infused Doppler echocardiography revealed a significant outflow gradient, and continuous monitoring showed Brockenbrough-Braunwald sign, which confirmed a diagnosis of latent left ventricular outflow tract obstruction due to a sigmoid septum. " 07/01/2016 - "We here present a case of AMV causing latent LVOT obstruction in an adolescent, which was diagnosed by echocardiography with dobutamine provocation and finally treated by successful surgical resection. " 01/01/2016 - "A dobutamine provocation test after normalization of the left ventricular wall motion reproduced the LVOT obstruction in all cases and revealed the presence of latent LVOT obstruction. " 06/01/2015 - "Moreover, LVOT obstruction was revealed after dobutamine infusion in the chronic phase and the aorto-septal angle was low in these two cases, meaning that latent LVOT obstruction was due to sigmoid-shaped septum. " 06/01/2013 - "Major determinants and possible mechanism of dobutamine-induced left ventricular outflow tract obstruction in patients with a sigmoid ventricular septum."
9.	Dichlorodiphenyldichloroethane (DDD)IBA 06/01/1992 - "The present study examines prospectively the ability of dual-chamber (DDD) pacing to improve symptoms and relieve left ventricular outflow obstruction in such patients. " 03/01/2000 - "This report describes a patient with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction who had failed to respond to DDD pacing but showed benefit from subsequent NSRT. " 12/01/1994 - "Despite the presence of left bundle branch block, DDD pacing reduced LVOT obstruction significantly in 15 patients (LVOT gradient, baseline 89 +/- 36 mm Hg versus 18 +/- 26 mm Hg at follow-up, P < .0001). " 01/01/1994 - "Indications for AVN ablation were drug refractory atrial fibrillation in 24 patients, and rapid AVN conduction preventing septal pre-excitation by DDD pacemaker, inserted for relief of left ventricular outflow obstruction, in three cases. " 08/01/1998 - "A case of hypertrophic obstructive cardiomyopathy with localized upper septal hypertrophy: reduction of left ventricular outflow obstruction by dual-chamber (DDD) pacing."
10.	Metoprolol (Toprol-XL)FDA LinkGeneric 12/21/2021 - "Compared with placebo, metoprolol reduced LVOT obstruction at rest and during exercise, provided symptom relief, and improved quality of life in patients with obstructive HCM. " 12/21/2021 - "This study aimed to investigate the effects of metoprolol on left ventricular outflow tract (LVOT) obstruction, symptoms, and exercise capacity in patients with obstructive HCM. " 12/01/2023 - "A 59-year-old man was referred for SSM as dyspnoea and low threshold muscle fatigue associated to severe left ventricular outflow obstruction (gradient of 100 mmHg) due to both interventricular septal hypertrophy and mitral leaflet systolic anterior motion were not controlled by metoprolol 100 mg bid. " 03/01/2010 - "Haemodynamic effects of acute intravenous metoprolol in apical ballooning syndrome with dynamic left ventricular outflow tract obstruction." 08/01/2023 - "This study aims to establish the benefits and therapeutic value metoprolol or verapamil offer to patients who suffer from symptoms caused by HCM, with regard to resolving left ventricular outflow tract obstruction (LVOTO), as well as improving a patient's quality of life and reducing symptoms. "

Therapies and Procedures

1.	Therapeutics 07/01/2008 - "Dual-chamber pacing therapy for the relief of symptoms caused by dynamic left ventricular outflow tract obstruction has a limited role because of the availability of more definitive therapies; less than 50% long-term symptom relief; less than 20% long-term relief from a combined end point of death, symptoms, surgery, residual gradient, or a combination of these; and the inability to appropriately identify those patients most likely to derive benefit." 10/01/1999 - "Nonsurgical septal reduction therapy results in significant reduction in left ventricular outflow tract (LVOT) obstruction and symptomatic improvement. " 01/01/2020 - "Surgical treatment is an effective therapy and the gold standard for patients with left ventricular outflow tract obstruction (LVOTO) and drug-refractory symptoms. " 10/02/2019 - "The Brockenbrough-Braunwald-Morrow phenomenon provides objective evidence of the existence and degree of left ventricular outflow tract (LVOT) obstruction, which can be improved with pharmacological therapy, surgical myectomy, or interventional alcohol septal ablation (ASA). " 07/01/2017 - "This paper traces the development of transaortic septal myectomy, the current gold standard therapy for relief of LVOT obstruction, in symptomatic patients refractory to medical treatment. "
2.	Prostheses and Implants (Prosthesis) 08/01/2022 - "This modified surgical technique is safe and effective and eliminates the risk of jamming of the prosthesis disk and left ventricular outflow tract obstruction." 10/01/2018 - "MR patients with preexisting aortic valve prosthesis have been excluded from most TMVR trials because of the potential risks of left ventricular outflow tract obstruction or interaction between the TMVR anchoring mechanism and the aortic prosthesis. " 01/01/1986 - "The inference that mitral valve replacement (MVR) may produce left ventricular outflow tract (LVOT) obstruction has been made, but no comparative hemodynamic studies with various types of prostheses have been done. " 01/01/2023 - "Furthermore, significant advances in device technology, delivery systems, and implantation techniques are essential to avoid left ventricular outflow tract obstruction, and valvular and paravalvular regurgitation as well as ensuring good anchoring of the prosthesis." 07/01/2021 - " opinion: In both aortic and mitral positions meticulous planning is fundamental in these procedures to avoid serious complications including patient prosthesis mismatch, coronary obstruction and left ventricular outflow tract obstruction."
3.	Radiofrequency Ablation 10/01/2022 - "In at-risk individuals, preemptive septal radiofrequency ablation may be an effective strategy at preventing left ventricular outflow tract obstruction with transcatheter mitral valve replacement." 10/01/2022 - "Valve replacement in the setting of mitral annular calcification was performed in all patients 89 (range, 38-45) days after preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement. " 10/01/2022 - "Preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement resulted in septal end-diastolic wall thickness reduction compared with baseline (28.6%, 30.4%, 30.3%, and 11.1%) and following alcohol septal ablation (23.1%, 12%, 8.5%). " 10/01/2022 - "Patients underwent preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement a range between 69 and 154 days after alcohol septal ablation. " 10/01/2022 - "We present a case series whereby preemptive septal radiofrequency ablation (RADIO-TMVR) was used to augment the left ventricular outflow tract for transcatheter mitral valve replacement in 4 patients at risk for left ventricular outflow tract obstruction despite alcohol septal ablation. "
4.	Stents 06/21/2023 - "Left Ventricular Outflow Obstruction After Transcatheter Heart Valve Migration and Stent Infolding." 01/01/2020 - "3DE-based preoperative modeling of surgical implantation of stent-based valves in the mitral position may improve quantification of mitral valve dimensions and inform risk stratification for potential LVOT obstruction." 12/01/2015 - "Cardiac CT was performed three weeks after implantation, with focus placed on stent design-related parameters: possible left ventricular outflow tract obstruction and stent shaping. " 10/01/2014 - "One patient who had not undergone distal stent fixation developed left ventricular outflow tract obstruction. " 04/01/2011 - "No valved stent migration, embolization, systolic anterior movement or left ventricular outflow tract obstruction was observed. "
5.	Drug Therapy (Chemotherapy) 10/01/2020 - "Surgical septal myectomy has long been considered the gold standard in pharmacotherapy-refractory severely symptomatic patients with marked left ventricular outflow tract (LVOT) obstruction. " 03/01/2019 - "Significant LVOT obstruction may develop in patients with BSH and is potentially responsive to pharmacotherapy. " 03/01/2015 - "There are a number of treatment modalities for these patients, including pharmacotherapy to control symptoms, implantable cardiac defibrillators to manage malignant arrhythmias, and surgical myectomy and septal ablation to decrease the left ventricular outflow obstruction. " 04/01/2007 - "The postpump IOTEE is also essential for numerous reasons: it can rule out important misfortunes, such as leaflet immobilization or perivalvular leak, leaky bioprosthesis or coronary obstruction due to valve struts, and is responsible for second pump-run in 3-6% of cases; it is essential in monitoring the deairing process; it provides the surgeon and the anesthesiologist data on biventricular function and volume and exclusion of dynamic left ventricular outflow tract obstruction, and, therefore, guides pharmacotherapy, volume handling and mechanical assistance, including intra-aortic balloon pump indication and location. " 05/01/1999 - "A 13-year-old boy with hypertrophic obstructive cardiomyopathy was treated with dual-chamber pacing after severe progression of left ventricular outflow tract obstruction and of clinical symptoms despite drug therapy. "