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Suicide left ventricle following transcatheter aortic valve implantation

William M Suh1, Christian F Witzke, Igor F Palacios

  • 1Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 28, 2010
PubMed

Insights

Transcatheter aortic valve implantation (TAVI) can cause dynamic intraventricular gradients in patients with aortic stenosis and left ventricular hypertrophy. Careful patient selection is crucial to avoid adverse hemodynamic events.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Aortic stenosis (AS) can lead to left ventricular hypertrophy (LVH) due to chronic pressure overload.
  • Dynamic intraventricular gradients, similar to hypertrophic obstructive cardiomyopathy, may develop in AS patients with LVH.
  • Transcatheter aortic valve implantation (TAVI) is increasingly used for elderly patients with severe AS, including those previously deemed high-risk for surgical valve replacement.

Observation:

  • This case report describes a patient who developed significant hemodynamic aberrations following TAVI.
  • The observed aberrations were attributed to dynamic intraventricular gradients.
  • These gradients arose secondary to pre-existing left ventricular hypertrophy from aortic stenosis.

Findings:

  • TAVI can precipitate or exacerbate dynamic intraventricular gradients in susceptible patients with LVH.
  • These gradients can lead to potentially serious hemodynamic compromise.
  • The findings underscore the importance of assessing left ventricular diastolic function and gradient risk before TAVI.

Implications:

  • A cautious approach is warranted when implementing TAVI in patients with LVH and potential for dynamic intraventricular gradients.
  • Pre-procedural echocardiographic evaluation should carefully assess for features predisposing to gradient formation.
  • Further research is needed to define optimal management strategies for these complex patients undergoing TAVI.

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