What is an RVOT?

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Can someone please explain what an RVOT (right ventricular outflow tract) is? Or LVOT? What does it do? What does that mean? Why would you need surgery on it? For reference I’m in the peds cardiac ICU.
thank you! ?

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

Usually only hear the terms when ppl refer to outflow tract obstructions. As I work in Cardiology, I will occasionally hear reference to LVOT obstruction, usually caused by HOCM (hypertrophic cardiomyopathy).. We do not work with pediatrics, which would present a whole different collection of causes of outflow tract obstructions. Briefly:

Re RVOT:

"Right ventricular outflow tract obstruction may be caused by defects of the pulmonary valve, adjacent parts of the right ventricle, and main pulmonary artery that cause obstruction of the outflow of blood from the right ventricle." https://empendium.com/mcmtextbook/chapter/B31.II.2.12.6.

Re LVOT:

"Left ventricular outflow tract obstruction (LVOTO) can occur at the valvular, subvalvular, or supravalvular level. In general, there is an obstruction to forward flow which increases afterload, and if untreated, can result in hypertrophy, dilatation, and eventual failure of the left ventricle. In the United States, most cases of LVOT obstruction are congenital in individuals younger than 50 years of age." https://www.ncbi.nlm.nih.gov/books/NBK470446/

Lots to look up. Thanks for the review!

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Great info by @dianah.

I like to think of it kind of like this: The left ventricular outflow tract (LVOT) describes where the blood flows when it leaves your left ventricle: the muscular part of your ventricle just before the valve, the aortic valve itself, and the aorta. To put it even more simply, the LVOT is literally just the aorta, and the part of the heart right before aorta. The term LVOT makes it sound like it's more complicated than it actually is.

The same is true with the RVOT: it's just the pulmonary artery, and the part of the heart just before the pulmonary artery (the muscular part of the right ventricle just before the pulmonic valve, and the pulmonic valve itself).

As @dianah said, an LVOT or RVOT obstruction just means there's something blocking the pathway of the blood as it flows out of the heart (I.e. a tumor, a clot, a hypertrophic segment of muscle). This has short-term and long-term effects. In the very short-term, you have to consider where the blood is obstructed from going; if you have a huge obstruction in your aorta, you won't be able to get blood out to your body, and you'll present with obstructive/distributive shock. In the long-term, the blockage can lead to higher pressures in affected side of the heart, which can then cause heart failure.

Now onto peds: You'll often hear heart defects described as "double outlet right," "double outlet left," "double inlet right," or "double inlet left."

Double outlet left ventricle just means that both great arteries (aorta and pulmonary arteries) "flow out" of the left side of the heart; in that defect, both the aorta and the pulmonary artery arise from the left ventricle (as opposed to aorta from the left, pulmonary artery from the right, as in a normal heart).

Similarly, double outlet right ventricle means that both great arteries (aorta and pulmonary arteries) flow out from the right ventricle. Conversely, double inlet left means that both great veins (vena cava and pulmonary veins) flow into the the left atrium. Double inlet right means that both great veins flow into the right atrium.

To clarify: all people have a left ventricular outflow tract (where the aorta leaves the heart) and a right ventricular outflow tract (where the pulmonary artery leaves the heart). You only need surgery if the outflow tracts are either obstructed, or if they're in the wrong place (or both).

The surgical repairs depend very much on the rest of the heart defect. If you've got an isolated outflow tract obstruction (for instance, a muscular hypertrophy right in front of the valve), you may be able to do surgery which simply removes the obstruction. We'll sometimes see this in Tets or pulmonary stenosis, where the muscle itself is very hypertrophied just before the pulmonic valve, which prevents blood from flowing to the lungs; the surgeons can go in and scrape out a bit of the muscle to make more room for the blood to flow out of the right heart.

However, if you've got a kid who has double inlet right, double inlet left, double outlet right, or double outlet left, you aren't just going to repair the inlet/outlet; rather, you're going to do surgery on the entire defect. The outflow obstruction will only be a small piece of the overall surgery.

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

I am constantly impressed with the level of expertise and understanding members like adventure_rn share with us! Thank you!

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1 hour ago, dianah said:

I am constantly impressed with the level of expertise and understanding members like adventure_rn share with us! Thank you!

Aww, thanks, that really made my day. ?

I learned everything I know from some very smart NPs, physicians, and teachers. I try to make extra time to teach whenever I can, because those people always made time to teach me.

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Thank you for your help!! I really appreciate it!! ?

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