Overcoming the Obstacle of Suicide Left Ventricle After TAVR Phenomenon (JACC Case Reports November 2023)-Article: Overcoming the Obstacle of Suicide Left Ventricle After TAVR Phenomenon

Article: Overcoming the Obstacle of Suicide Left Ventricle After TAVR Phenomenon

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This case report discusses the phenomenon of "suicide left ventricle" after transcatheter aortic valve replacement (TAVR) and highlights the successful recognition, prevention, and treatment of this complication. The patient in the case was a 79-year-old man with severe aortic stenosis who underwent TAVR. Pre-TAVR evaluation revealed a systolic 5/6 heart murmur and left ventricular outflow tract (LVOT) obstruction with a peak gradient of 81 mm Hg. Measures were taken to decrease the LVOT gradient and increase LV preload before the procedure. During TAVR, the patient presented with mild bilateral leg edema but no dyspnea. The LVOT peak gradient was reduced to 34 mm Hg. Hemodynamic measurements showed a decrease in the LVapex-Aorta mean gradient after temporary right ventricular (RV) pacing. The TAVR procedure was successful, but the patient experienced hypotension post-procedure. Prompt treatment with IV saline solution and phenylephrine infusion resolved the hypotension. Follow-up echocardiography showed a well-functioning prosthetic valve and a further reduction in the LVOT peak gradient. The authors emphasize the importance of recognizing the "suicide left ventricle" phenomenon and implementing preventive and therapeutic measures. Preventive measures include increasing LV preload and afterload and implementing RV pacing. Therapeutic measures may include the use of vasoconstrictive agents and short-acting beta-blockers. The authors conclude that simple measures can successfully prevent and treat the "suicide left ventricle" phenomenon, improving clinical outcomes.

Keywords

suicide left ventricle

transcatheter aortic valve replacement

TAVR

complication

aortic stenosis

LVOT obstruction

LVOT gradient

bilateral leg edema

hypotension

prosthetic valve