Key result
Medical management and pacemaker reprogramming resolve post-TAVI suicide LV and a ~106 mmHg LVOT gradient.
Why the study?
Abrupt afterload reduction following TAVI in patients with a small, hypertrophic left ventricle can trigger dynamic LVOTO and hypotension, known as suicide left ventricle. Early recognition of this post-TAVI diagnostic and therapeutic challenge is crucial because standard treatments may aggravate the obstruction.
Case Report (n=1)
No
Early echocardiographic recognition of post-TAVI suicide left ventricle and pathophysiology-driven management (IV fluids, beta-blockade with esmolol, diuretic avoidance, and pacemaker reprogramming) are critical to reverse severe dynamic LVOTO and prevent progression to shock.
Answers are grounded in this paper and cite their sources.
Raises awareness of suicide LV post-TAVI in hypertrophic ventricles; leaves open prospective validation of screening and prevention.
Background: Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis leads to haemodynamic improvement. Patients with a small, hypertrophic left ventricle are predisposed to dynamic left ventricular outflow tract obstruction (LVOTO). Abrupt afterload reduction may trigger “suicide left ventricle”, characterised by hypercontractility, near-complete cavity obliteration, systolic anterior motion (SAM)-related LVOTO, and hypotension. Early recognition is crucial because treatments may aggravate the obstruction. Case presentation: A 78-year-old man with hypertension, dyslipidaemia, severe calcific tricuspid aortic stenosis, LV hypertrophy, small LV cavity, and bifascicular block underwent pre-TAVI evaluation. Coronary angiography excluded obstructive coronary disease; because of recurrent syncope, a dual-chamber pacemaker was implanted before TAVI. After transfemoral implantation of a 29 mm Medtronic Evolut FX+ bioprosthesis, the patient developed dyspnoea and hypotension. Bleeding, arrhythmias, and cardiac tamponade were excluded, and no evidence of an acute structural prosthetic complication was identified. Echocardiography showed SAM, a hyperdynamic LV with near-complete systolic cavity obliteration, and a 106 mmHg LVOT gradient with a “dagger-shaped” profile. Intravenous fluid administration, avoidance of diuretics, esmolol, and pacemaker reprogramming were followed by haemodynamic stabilisation and a reduction in LVOTO. Conclusions: Suicide left ventricle is a rare cause of post-TAVI hypotension; male sex and delayed haemodynamic instability were atypical. Early echocardiographic recognition, post-procedural monitoring, and pathophysiology-driven management were paramount for preventing progression to shock.
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Pepe et al. (2026) conducted a case report in Severe calcific tricuspid aortic stenosis complicated by post-TAVI suicide left ventricle (n=1). Intravenous fluid administration, avoidance of diuretics, esmolol, and pacemaker reprogramming after 29 mm Medtronic Evolut FX+ TAVI was evaluated on Haemodynamic stabilisation and reduction in left ventricular outflow tract obstruction (LVOTO). IV fluids, esmolol, diuretic avoidance, and pacemaker reprogramming resolved post-TAVI suicide LV with a 106 mmHg LVOT gradient in a 78-year-old man.
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