Recognition of Left Ventricular Outflow Obstruction.

THE PURPOSE of this paper is to summarize the clinical, hemodynamic, and angiographic aspects of valvular, subvalvular, and supravalvular aortic stenosis, with emphasis upon recognition of the more severe grades of the diseases that may require operation. A basic feature of obstruction to left ventricular outflow is the need for the ventricle to produce high systolic pressure; a systolic pressure gradient across the obstruction is present. The chronic elevation of left ventricular pressure is associated with left ventricular hypertrophy, which may also cause hemodynamic abnormalities. The bedside findings constitute the essential first step in assessing these physiologic abnormalities, to select those patients who will require left heart catheterization and may need surgical relief.