When the heart becomes suicidal: a case report of severe left ventricular outflow tract obstruction following transcatheter aortic valve implantation

Replacement of the aortic valve is a Class I recommendation for treatment of patients suffering from severe, symptomatic aortic stenosis. However, aortic valve replacement can occasionally lead to complications, including development of acute left ventricular outflow tract (LVOT) obstruction. This rare but severe complication is referred to as the so-called ‘suicide left ventricle’ phenomenon.

This case report presents an 88-year-old woman who developed severe LVOT obstruction following a successful transcatheter aortic valve implantation (TAVI), complicated by septal anterior motion of the mitral valve resulting in severe mitral regurgitation. Despite initial intensive care management, her symptoms persisted, necessitating the application of transcoronary ablation of septal hypertrophy as a bail-out procedure. Transcoronary ablation of septal hypertrophy, typically used in hypertrophic obstructive cardiomyopathy, successfully reduced the LVOT gradient and relieved symptoms.

This case emphasizes the importance of pre-operative identification of LVOT obstruction risk factors, awareness for this complication and a well-experience multidisciplinary team for the management of TAVI-associated complications.