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Zeng YH, Calderone A, Rousseau-Saine N, Elmi-Sarabi M, Jarry S, Couture ÉJ, Aldred MP, Dorval JF, Lamarche Y, Miles LF, Beaubien-Souligny W, Denault AY. Right Ventricular Outflow Tract Obstruction in Adults: A Systematic Review and Meta-analysis. CJC Open 2021; 3:1153-1168. [PMID: 34746729 PMCID: PMC8551422 DOI: 10.1016/j.cjco.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Right ventricular outflow tract obstruction (RVOTO) is a cause of hemodynamic instability that can occur in several situations, including cardiac surgery, lung transplantation, and thoracic surgery, and in critically ill patients. The timely diagnosis of RVOTO is important because it requires specific considerations, including the adverse effects of positive inotropes, and depending on the etiology, the requirement for urgent surgical intervention. Methods The objective of this systematic review and meta-analysis was to determine the prevalence of RVOTO in adult patients, and the distribution of all reported cases by etiology. Results Of 233 available reports, there were 229 case reports or series, and 4 retrospective cohort studies, with one study also reporting a prospective cohort. Of 291 reported cases of RVOTO, 61 (21%) were congenital, 56 (19%) were iatrogenic, and 174 (60%) were neither congenital nor iatrogenic (including intracardiac tumour). The mechanism of RVOTO was an intrinsic obstruction in 169 cases (58%), and an extrinsic obstruction in 122 cases (42%). A mechanical obstruction causing RVOTO was present in 262 cases (90%), and 29 cases of dynamic RVOTO (10%) were reported. In the 5 included cohorts, with a total of 1122 patients, the overall prevalence was estimated to be 4.0% (1%-9%). Conclusions RVOTO, though rare, remains clinically important, and therefore, multicentre studies are warranted to better understand the prevalence, causes, and consequences of RVOTO.
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Affiliation(s)
- Yu Hao Zeng
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander Calderone
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Rousseau-Saine
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mahsa Elmi-Sarabi
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Stéphanie Jarry
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Étienne J Couture
- Department of Anesthesiology and Department of Medicine, Division of Intensive Care Medicine, Quebec Heart & Lung Institute, Quebec, Quebec, Canada
| | - Matthew P Aldred
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Francois Dorval
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Lachlan F Miles
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia and Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - William Beaubien-Souligny
- Department of Medicine, Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - André Y Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Kokotsakis J, Rouska EG, Harling L, Ashrafian H, Anagnostakou V, Charitos C, Athanasiou T. Right ventricular outflow tract obstruction caused by double-chambered right ventricle presenting in adulthood. Tex Heart Inst J 2014; 41:425-8. [PMID: 25120399 DOI: 10.14503/thij-13-3398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Congenital heart diseases that cause obstruction of the right ventricular outflow tract are often difficult to diagnose. We report the case of a 49-year-old man who presented with long-standing shortness of breath on exertion. Imaging revealed right ventricular outflow tract obstruction caused by a double-chambered right ventricle, and he was referred for surgical correction. This case emphasizes both the detailed perioperative evaluation that is needed when diagnosing adults who present with manifestations of congenital heart disease and a method of successful surgical correction that resulted in symptom resolution.
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Affiliation(s)
- John Kokotsakis
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Efthymia G Rouska
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Leanne Harling
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Hutan Ashrafian
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Vania Anagnostakou
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Christos Charitos
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Thanos Athanasiou
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
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