Citation

Naseerullah FS, Wickramasinghe SR. J. Cardiol. Cases 2022; 26(3): 236-238.

Copyright

(Copyright © 2022, Japanese College of Cardiology, Publisher Elsevier Publishing)

DOI

10.1016/j.jccase.2022.05.006

PMID

unavailable

Abstract

Suicide left ventricle (SLV) is a well-documented complication after surgical or transcatheter aortic valve replacement. We present an unusual case of a patient who developed left ventricular outflow tract (LVOT) obstruction with a native aortic valve, resulting in SLV after routine non-cardiac surgery. A 45-year-old male presented to the emergency room with abdominal pain and was diagnosed with acute cholecystitis. The patient had a known medical history of severe left ventricular hypertrophy. The patient underwent an uncomplicated laparoscopic cholecystectomy. Post-operatively, he went into shock during weaning from anesthesia. He was started on norepinephrine followed by epinephrine and vasopressin, without much improvement. Increasing doses of vasopressors failed to improve the patient's hemodynamics. A presumptive diagnosis of SLV was made. This was secondary to hemodynamic collapse due to vasoplegia from anesthesia, worsening LVOT obstruction and subsequent right ventricular failure. Despite being in shock, the patient was taken off pressors and started on esmolol infusion to increase diastolic filling and epoprostenol to decrease the right ventricle strain by pulmonary vasodilation. The patient responded promptly to these measures. A repeat echocardiogram showed a significant improvement in right and left ventricular function. Learning objective: Suicide left ventricle (SLV) is commonly seen in patients post aortic valve replacement. It presents as shock which does not respond to pressors and instead is treated by beta-blockers. Our patient developed SLV pathophysiology despite having native aortic valve. He developed shock which did not improve with pressors but responded to esmolol. This emphasizes the importance of fluid management in patients with severe left ventricular outflow tract obstruction. It also gives a different perspective to managing shock in such patients who are not responding to pressors. © 2022 Elsevier Ltd

Language: en

Keywords

adult; human; male; case report; abdominal pain; hemodialysis; antihypertensive agent; clinical article; tachycardia; middle aged; noradrenalin; lung embolism; backache; nausea; drug withdrawal; hemodynamics; hypotension; sodium chloride; hypertension; heart left ventricle function; epigastric pain; endotracheal intubation; thorax radiography; postoperative complication; heart catheterization; treatment response; vasopressin; Article; Shock; drug dose increase; heart left ventricle ejection fraction; prostacyclin; heart left ventricle hypertrophy; drug substitution; hypokinesia; transthoracic echocardiography; ECG abnormality; computed tomographic angiography; ST segment; cardiogenic shock; T wave; hypertrophic cardiomyopathy; heart atrium enlargement; echocardiography; heart left ventricle failure; esmolol; mitral valve regurgitation; abdominal tenderness; aortic stenosis; suicide left ventricle; antihypertensive therapy; end stage renal disease; acute cholecystitis; left ventricular systolic dysfunction; tricuspid valve regurgitation; heart right ventricle failure; repeat procedure; epinephrine; coronary angiography; abnormal blood pressure; heart right ventricle hypertrophy; heart left ventricle outflow tract obstruction; anesthetic recovery; etifenin; heart preload; heart right ventricle function; heart volume; laparoscopic cholecystectomy; left ventricular diastolic dysfunction; Left ventricular hypertrophy; postoperative vasoplegia; Right ventricular failure; Suicide left ventricle