Chraibi Hamza, Bakamel Lamyaa, Fellat Rokya, Bendagha Nesma, Moughil Said
Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, MAR.
Cardiovascular Surgery B Department, Ibn Sina Hospital, Mohammed V University, Rabat, MAR.
Cureus. 2023 Aug 3;15(8):e42890. doi: 10.7759/cureus.42890. eCollection 2023 Aug.
Suicide left ventricle (SLV) remains an underdiagnosed cause of haemodynamic compromise following surgical or transcatheter aortic valve replacement (AVR). Risk factors include female sex and a small left ventricular cavity with asymmetric septal hypertrophy. We present the case of a 63-year-old woman, with a medical history of diabetes mellitus, arterial hypertension and dyslipidaemia who was diagnosed with severe aortic stenosis with normal left ventricular ejection fraction and concentric hypertrophy. She underwent surgical AVR using a bioprosthetic valve, but a few hours after surgery, she developed sudden cardiogenic shock. An urgent transthoracic echocardiogram was performed showing marked systolic anterior motion of the mitral valve resulting in severe dynamic left ventricular outflow tract obstruction and intraventricular gradient. The diagnosis of SLV was made. The patient was managed conservatively with volume loading and oral beta-blockers and her haemodynamic state improved gradually. She was then discharged after favourable evolution. Medical management of SLV includes volume loading to expand the ventricular volume and beta-blockers for their negative inotrope effect. When medical therapy fails, surgical myectomy or alcohol septal ablation can be proposed to remove the obstacle. Some authors have proposed these procedures as prophylactic measures to prevent SLV in high-risk patients.
自杀性左心室（SLV）仍是外科手术或经导管主动脉瓣置换术（AVR）后血流动力学受损的一个诊断不足的原因。危险因素包括女性以及伴有不对称性室间隔肥厚的小左心室腔。我们报告一例63岁女性病例，其有糖尿病、动脉高血压和血脂异常病史，被诊断为严重主动脉瓣狭窄，左心室射血分数正常且为向心性肥厚。她接受了生物瓣膜置换的外科AVR手术，但术后数小时出现了心源性休克。紧急经胸超声心动图显示二尖瓣明显的收缩期前向运动，导致严重的动态左心室流出道梗阻和心室内压差。诊断为SLV。患者接受了容量负荷和口服β受体阻滞剂的保守治疗，其血流动力学状态逐渐改善。随后病情好转出院。SLV的药物治疗包括容量负荷以扩大心室容积以及使用具有负性肌力作用的β受体阻滞剂。当药物治疗无效时，可考虑进行外科室间隔心肌切除术或酒精室间隔消融术以消除梗阻。一些作者已提议将这些手术作为预防高危患者发生SLV的预防性措施。
