Suicidal Left Ventricle After Transcatheter Aortic Valve Replacement Causing Cardiogenic Shock

The "suicidal left ventricle" (LV) is a rare but potentially fatal complication after transcatheter aortic valve replacement (TAVR), caused by dynamic LV outflow tract obstruction following abrupt afterload reduction.

A 77-year-old woman with severe symptomatic aortic stenosis underwent successful TAVR. Shortly after the procedure, she developed hypotension, hypoperfusion, and cardiogenic shock. Initial management with fluids and vasopressors provided transient improvement; however, inotropic support worsened her condition. Urgent transthoracic echocardiography revealed a small, hyperdynamic LV with a dagger-shaped dynamic intraventricular gradient, without prosthetic dysfunction. A diagnosis of suicidal LV was established. Inotropes were discontinued, and treatment with volume expansion, vasopressors, and beta-blockers led to rapid hemodynamic recovery.

This case highlights the importance of early recognition of dynamic obstruction after TAVR and the need for targeted hemodynamic management, which differs from the conventional cardiogenic shock treatment.

Early echocardiographic diagnosis and avoidance of inotropes are critical to reverse this potentially reversible cause of cardiogenic shock after TAVR.