Romano Silvia, D'Andrea Emilio, Cozac Dan Alexandru, Savo Maria Teresa, Cecchetto Antonella, Baritussio Anna, Martini Marika, Napodano Massimo, Bauce Barbara, Pergola Valeria
Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy.
Doctoral School of the University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania.
J Clin Med. 2024 Sep 19;13(18):5555. doi: 10.3390/jcm13185555.
Aortic stenosis (AS) is the most prevalent valvular heart disease in Europe and North America, with transcatheter aortic valve implantation (TAVI) revolutionizing its management. Hypertrophic left ventricle (HLV) frequently coexists with AS, complicating treatment due to the associated risk of left ventricular outflow tract (LVOT) obstruction, heart failure, and sudden death. A rare but severe post-aortic valve replacement (AVR) complication, termed "suicide left ventricle" (SLV), has emerged, necessitating further study. This report synthesizes current literature on SLV, its pathophysiology, and management strategies, alongside four patient case studies. The patients aged 79-87 years, underwent AVR for symptomatic AS with HLV. Post-AVR, all experienced severe complications, including dynamicLVOT gradients, systolic anterior motion (SAM) of the mitral valve, and severe hypotension, leading to death in two cases. One patient survived following surgical aortic valve replacement (SAVR) with surgical myectomy. One patient survived after TAVI. These cases highlight the critical importance of multidisciplinary Heart Team evaluations and personalized treatment plans in managing SLV. Despite advancements in AVR, SLV remains a complex, life-threatening condition, requiring an exhaustive and multifaceted approach for optimal patient outcomes. This report offers valuable insights into SLV occurrence and management from a clinical perspective.
主动脉瓣狭窄（AS）是欧洲和北美的最常见瓣膜性心脏病，经导管主动脉瓣植入术（TAVI）彻底改变了其治疗方式。肥厚型左心室（HLV）常与AS并存，由于存在左心室流出道（LVOT）梗阻、心力衰竭和猝死的相关风险，使治疗变得复杂。一种罕见但严重的主动脉瓣置换术（AVR）后并发症，称为“自杀性左心室”（SLV）已出现，需要进一步研究。本报告综合了关于SLV、其病理生理学和管理策略的当前文献，以及四个患者病例研究。这些患者年龄在79 - 87岁之间，因有症状的AS合并HLV接受了AVR。AVR后，所有患者都经历了严重并发症，包括动态LVOT梯度、二尖瓣收缩期前向运动（SAM）和严重低血压，导致两例患者死亡。一名患者在接受外科主动脉瓣置换术（SAVR）并进行外科心肌切除术之后存活。一名患者在接受TAVI后存活。这些病例突出了多学科心脏团队评估和个性化治疗方案在管理SLV中的至关重要性。尽管AVR取得了进展，但SLV仍然是一种复杂的、危及生命的病症，需要采用详尽且多方面的方法以实现最佳患者预后。本报告从临床角度为SLV的发生和管理提供了有价值的见解。
