Left Ventricular Outflow Tract Obstruction Following Mitral Valve Replacement: Challenges for Transcatheter Mitral Valve Therapy

ABSTRACT

In the race to develop a transcatheter mitral valve, experience with new techniques and devices has resulted in revisiting a previously known complication of surgical mitral valve replacement and repair: left ventricular outflow tract obstruction. This entity, first described in 1977, is dynamic in nature in many cases and multifactorial. The ability to appropriately predict and treat this complication rests on a thorough understanding of the pathophysiology and anatomical considerations. This review will review the pathophysiology of left ventricular outflow obstruction, discuss important pre-procedure imaging, procedural evaluation of obstruction, and therapeutic options.

KEYWORDS:

• LVOT obstruction
• mitral valve replacement
• transcatheter mitral valve replacement

Disclosure statements

Dr. Asgar is a consultant for Medtronic, Edwards LifeSciences and Abbott Vascular.

The remaining authors have no conflicts of interest in this work.