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[A case of left ventricular outflow tract obstruction after repair of ostium primum defect]
Insights
A rare complication of ostium primum defect repair, left ventricular outflow tract obstruction, can occur in children. Surgical intervention, including myectomy, effectively resolved the obstruction in a pediatric patient, highlighting the need for long-term follow-up.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
Background:
- Ostium primum defects are a type of atrioventricular septal defect often repaired in infancy.
- Surgical repair aims to correct the anatomical abnormalities and restore normal blood flow.
- Potential complications following repair require careful monitoring and management.
Observation:
- A 3-year-old girl developed left ventricular outflow tract obstruction (LVOTO) two years after ostium primum defect repair.
- Clinical presentation included left ventricular hypertrophy and a systolic ejection murmur.
- Diagnostic imaging revealed discrete stenosis in the left ventricular outflow tract.
Findings:
- Cardiac catheterization quantified a significant peak systolic gradient of 63 mmHg across the LVOT.
- Reoperation involved excision of fibrous tissue and myectomy to relieve the obstruction.
- Post-operative assessment confirmed the complete resolution of the LVOT gradient.
Implications:
- LVOTO is a potential, albeit uncommon, complication following surgical repair of atrioventricular septal defects.
- Prompt diagnosis and surgical management can effectively treat this complication.
- Long-term surveillance is crucial for patients who have undergone repair of atrioventricular septal defects to detect delayed complications like LVOTO.
Abstract:
We report a 3-year-old girl with left ventricular outflow tract obstruction after repair of ostium primum defect. The girl had closure of an ostium primum defect performed at the age of 1 year. Two years later, she developed left ventricular hypertrophy with systolic ejection murmur. Echocardiography showed discrete stenosis of the left ventricular outflow tract. Cardiac catheterization showed a peak systolic gradient of 63 mmHg across the left ventricular outflow tract. At the reoperation, the fibrous tissue was excised and myectomy was done. After the operation the peak systolic gradient across the left ventricular outflow tract disappeared. Since there is a possibility of occurrence of the left ventricular outflow tract obstruction after repair of atrioventricular septal defect, long term follow up is mandatory.