An expert overview of left ventricular outflow tract obstruction (LVOTO)

Left ventricular outflow tract obstruction (LVTO) is a heart problem which takes place in the main ventricle of the heart, which can cause an array of symptoms. Renowned consultant cardiologist Dr Antonis Pantazis explains everything you need to know about the condition.

What is left ventricular outflow tract obstruction (LVOTO)?

The left ventricle is the main ventricle of the heart. Left ventricular outflow tract obstruction (LVOTO) is a blockage in the exit, which is the outflow tract of the left ventricle.

This obstruction is often caused by the combination of abnormally thickened muscle, the abnormal move of one of the valves of the left ventricle (the mitral valve) and the overall dynamic, movement of the left ventricle. This is particularly common when hypertrophic cardiomyopathy is diagnosed as an underlying condition.

What causes LVOTO?

There are multiple factors which can contribute to ventricular outflow tract obstruction (LVOTO) obstruction of the left ventricle.

Increased thickness of the muscle of the left ventricle and abnormalities of the mitral valve are common contributing factors to ventricular outflow tract obstruction. (LVOTO)

Another cause of LVOTO is when there is the presence of some additional muscles inside the left ventricle, which are called papillary muscles.

LVOTO is a multifactorial phenomenon and is very common in hypertrophic cardiomyopathy, especially on exertion, such as when the patient is undertaking any physical activity or exercising. It is less frequent at rest or when the patient is sleeping.

What are the symptoms of LVOTO?

Left ventricular outflow tract obstruction can cause breathlessness, chest pain and near fainting or fainting episodes.  This will typically happen when the patient is:

• Exercising
• Dehydrated
• In a hot environment,
• After having a big meal
• Has consumed alcohol

These are just a few of the factors which can predispose to left ventricular outflow tract obstruction.

LVTO is quite dynamic; it may come and ago. Patients often report having both good and bad daysç because this LVTO lcan occur one day, when the circumstances are more likely to cause it, but may not occur the following day.

Patients with LVTO often have difficulties walking up the stairs or hills and may struggle to climb.

 Is LVOTO life-threatening?

LOVTO can provoke a lot of symptoms. It is not directly life-threatening, however, it can contribute to life-threatening risks. It is of course dangerous for the heart to be blocked when the it is attempting to pump blood out and is most likely related to the occurrence of arrhythmias, which then become life-threatening.

Furthermore, if the heart has another problem, the left ventricular heart obstruction can worsen cardiac problems.

There is no direct link between obstruction and risks but the main problem with obstruction is that it causes regular symptoms.

How is LVOTO treated?

For the management of LVOTO, we use a number of drugs /medications, which must be used with caution. This is because although they have a positive effect on the obstruction, they also have some negative side effects.

This means that we need to find the correct combination and the right balance of drugs which will be beneficial for the patient.

In some cases, the medication doesn’t work for the patient and therefore we need to look for other options. We have a number of interventional options and a surgical operation (surgical myectomy)

which is considered the gold standard of the management of obstruction because it corrects the thick wall of the heart, the abnormalities of the valve and everything else that contributes to obstruction within the left ventricle.

In the past we offered the treatment to patients who were asymptomatic /very symptomatic. However, given that the risks associated with the operation are becoming significantly reduced in large, experienced centres, there is a discussion that we should be offering this treatment to patients very earlier than what we used to.

If you are experiencing any cardiological issues and would like to book a consultation with Dr Pantazis, simply visit his Top Doctors profile today.