Citation

Lioufas PA, Kelly DN, Brooks KS, Marasco SF. Eur. Heart J. Case Rep. 2022; 6(2).

Copyright

(Copyright © 2022, Oxford University Press)

DOI

10.1093/ehjcr/ytac020

PMID

unavailable

Abstract

BACKGROUND: Suicide left ventricle is a well-documented phenomenon occurring after valve replacement, however, it is most commonly described in the mitral valve replacement (MVR) and transcatheter aortic valve replacement (TAVR) population. Cases within the surgical aortic valve replacement (SAVR) population usually resolve with optimal medical and interventional therapies. We describe a case of left ventricular suicide following SAVR presenting with persistent haemodynamic instability despite currently accepted medical and surgical therapies. Case summary: A 62-year-old male with severe aortic stenosis presented for SAVR and a MAZE procedure. There were no significant signs of ventricular hypertrophy on preoperative transthoracic echocardiogram (TTE). Intraoperatively, there was mild chordal systolic anterior motion of the mitral valve (SAM) which only occurred when underfilled. During recovery in the intensive care unit, the patient's pulmonary arterial pressures were noted to rise with worsening cardiac output. Subsequent TTE showed severe dynamic left ventricular outflow tract (LVOT) obstruction secondary to SAM. Due to refractory medical management, an alcohol septal ablation was performed. Despite resolution of obstruction, the patient exhibited biochemical signs of systemic hypoperfusion, and thus veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated. Following 72 h of VA-ECMO support, the patient was weaned with complete resolution of biochemical insults. He was subsequently discharged from the hospital without complication.

DISCUSSION: Compared to the TAVR population, suicide ventricle post-SAVR is comparatively rare. Patients who exhibit persistent impaired cardiac output postoperatively should be investigated rapidly with echocardiography. Furthermore, resolution of a LVOT obstruction state from procedural intervention may not immediately follow with improved cardiac output, and may require further supportive management. © 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.

Language: en

Keywords

adult; human; male; case report; Case report; Cardiogenic shock; clinical article; middle aged; intensive care unit; follow up; amiodarone; Echocardiography; heart surgery; vasopressin; metoprolol; Article; heart hemodynamics; heart left ventricle hypertrophy; transthoracic echocardiography; tooth extraction; phenylephrine; sleep disordered breathing; heart output; heart function; milrinone; systolic heart murmur; gold standard; heart left ventricle failure; sinus rhythm; moxonidine; metaraminol; telmisartan; suicide left ventricle; apixaban; Acute heart failure; heart left bundle branch block; Extracorporeal membrane oxygenation; biochemical analysis; first degree atrioventricular block; veno-arterial ECMO; perfusion; heart left ventricle outflow tract obstruction; continuous positive airway pressure; alcohol septal ablation; aortic clamping; aortic valve replacement; Aortic valve replacement; aortic valve stenosis; bacterial endocarditis; bicuspid aortic valve; bladder diverticulum; cardiac index; lung artery pressure; maze procedure; mitral valve; paroxysmal atrial fibrillation