Left ventricular outflow tract obstruction secondary to cone reconstruction for Ebstein’s anomaly: A case report / 中国胸心血管外科临床杂志

@#Left ventricular outflow tract obstruction (LVOTO) in Ebstein's anomaly is a rare complication, and LVOTO related to surgery is rarer. We present a 46 years old female patient who was dignosed with Ebstein's anomaly, then suffered from cardiac arrest because of LVOTO secondary to cone reconstruction in ICU.

[The left outflow tract: Abnormal features]. / La voie d'éjection gauche : aspects inhabituels.

The good knowledge of the characteristics of the left outflow tract allows us to detect but also to identify anomalies such as conal VSD and conotruncal anomalies. The analysis of this specific area of the heart must always be performed as part of a global analysis of the outflow tracts, combining the analysis of the right outflow tract with the assessment of the three vessel and trachea view.

[The left outflow tract: Normal features]. / La voie d'éjection gauche : aspects habituels.

Congenital heart disease remains an important cause of perinatal morbidity and mortality. Screening for these is based on a good knowledge of normal fetal heart anatomy and ultrasound views to be performed. After recommending the use of the four chambers and the right outflow tract views in 2005, CNEOF proposes recently adding the left outflow tract assessment. The use of this one should sensitize the operator to the notion of sweeping essential to obtain all these views and make it possible to improve the detection of the conal VSD and conotruncal pathologies.

Differentiating the origin of outflow tract ventricular arrhythmia using a simple, novel approach.

BACKGROUND: Numerous electrocardiographic (ECG) criteria have been proposed to identify localization of outflow tract ventricular arrhythmias (OT-VAs); however, in some cases, it is difficult to accurately localize the origin of OT-VA using the surface ECG. OBJECTIVE: The purpose of this study was to assess a simple criterion for localization of OT-VAs during electrophysiology study. METHODS: We measured the interval from the onset of the earliest QRS complex of premature ventricular contractions (PVCs) to the distal right ventricular apical signal (the QRS-RVA interval) in 66 patients (31 men aged 53.3 ± 14.0 years; right ventricular outflow tract [RVOT] origin in 37) referred for ablation of symptomatic outflow tract PVCs. We prospectively validated this criterion in 39 patients (22 men aged 52 ± 15 years; RVOT origin in 19). RESULTS: Compared with patients with RVOT PVCs, the QRS-RVA interval was significantly longer in patients with left ventricular outflow tract (LVOT) PVCs (70 ± 14 vs 33.4±10 ms, P < .001). Receiver operating characteristic analysis showed that a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 100%, 94.6%, 93.5%, and 100%, respectively, for prediction of an LVOT origin. The same analysis in the validation cohort showed sensitivity, specificity, and positive and negative predictive values of 94.7%, 95%, 95%, and 94.7%, respectively. When these data were combined, a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 98%, 94.6%, 94.1%, and 98.1%, respectively, for prediction of an LVOT origin. CONCLUSION: A QRS-RVA interval ≥49 ms suggests an LVOT origin. The QRS-RVA interval is a simple and accurate criterion for differentiating the origin of outflow tract arrhythmia during electrophysiology study; however, the accuracy of this criterion in identifying OT-VA from the right coronary cusp is limited.