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Eur J Cardiothorac Surg 2007;31:1013-1021. doi:10.1016/j.ejcts.2007.03.015
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Review

Management options in neonates and infants with critical left ventricular outflow tract obstruction

Bahaaldin Alsoufia,b,*, Tara Karamloua, Brian W. McCrindlea, Christopher A. Caldaronea

a The Cardiac Center, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
b King Faisal Heart Institute at King Faisal Specialist Hospital and Research Center. Riyadh, Saudi Arabia

Received 6 January 2007; received in revised form 6 March 2007; accepted 9 March 2007.

* Corresponding author. Address: King Faisal Heart Institute (MBC 16), King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia. Tel.: +966 1 464 7272x39455; fax: +966 1 442 7791. (Email: balsoufi{at}hotmail.com).

Despite being one of the most common congenital cardiac abnormalities, the treatment of critical left ventricular outflow tract obstruction (LVOTO) in the neonate and infant remains a significant challenge. Critical LVOTO in the neonate and infant includes continuous and diverse spectrum of anatomic diagnoses ranging from hypoplastic left heart complex to isolated aortic valvular stenosis with otherwise normally formed left heart structures. Depending on related anatomic features, there are multiple single ventricle and biventricular management strategies available for patients with critical LVOTO; all of which carry significant risk of death and requirement for future interventions. Because of the wide array of morphologic lesions and physiologic manifestations, application of the currently available published data to guide decision making in the individual patients can be challenging. Therefore, the aim of this review is to describe the different therapeutic strategies that can be applied to neonates presenting with critical LVOTO taking into consideration each patient's unique physiologic and anatomic findings.

Key Words: Congenital heart disease • Aortic stenosis • Valvotomy • Transplantation • Norwood






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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.