Schulz Carl, Brunner Fabian J, Pecha Simon, Sörensen Nils, Schofer Niklas
Department of Cardiology, University Medical Center Hamburg-Eppendorf, Martinistreet 52, 20251 Hamburg, Germany.
Department for Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistreet 52, 20251 Hamburg, Germany.
Eur Heart J Case Rep. 2025 May 7;9(5):ytaf164. doi: 10.1093/ehjcr/ytaf164. eCollection 2025 May.
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.
对于患有严重症状性主动脉瓣狭窄的患者，主动脉瓣置换是I类推荐的治疗方法。然而，主动脉瓣置换偶尔会导致并发症，包括急性左心室流出道（LVOT）梗阻的发生。这种罕见但严重的并发症被称为所谓的“自杀性左心室”现象。
本病例报告介绍了一名88岁女性，在成功进行经导管主动脉瓣植入术（TAVI）后发生严重LVOT梗阻，并伴有二尖瓣前叶间隔运动导致严重二尖瓣反流。尽管最初进行了重症监护管理，但其症状仍持续存在，因此需要应用经冠状动脉间隔肥厚消融术作为挽救措施。经冠状动脉间隔肥厚消融术通常用于肥厚性梗阻性心肌病，成功降低了LVOT梯度并缓解了症状。
本病例强调了术前识别LVOT梗阻危险因素、认识这种并发症以及拥有经验丰富的多学科团队来管理TAVI相关并发症的重要性。
