Suicide left ventricle after aortic valve intervention: Mechanisms, risk phenotypes, and clinical considerations

Suicide left ventricle (SLV) is a rare but potentially catastrophic complication of surgical or transcatheter aortic valve replacement, characterized by acute hemodynamic collapse after relief of aortic stenosis. Abrupt reduction in left ventricular afterload unmasks dynamic intracavitary obstruction driven by adverse ventricular geometry, hypercontractility, and impaired filling, resulting in a low-cardiac output state. Although increasingly recognized, SLV remains a rare yet potentially fatal condition that continues to pose diagnostic and therapeutic challenges. This review synthesizes available evidence on the mechanistic basis of SLV presents an operational framework for recognition, highlighting key clinical and echocardiographic features associated with susceptibility to this complication. We discuss a practical, physiology-guided management approach, including pharmacologic modulation, pacing strategies, septal reduction approaches, and selective use of mechanical circulatory support. Improved awareness and coordinated multidisciplinary care may help mitigate morbidity and optimize outcomes for this severe condition.