Suicide Left Ventricle During Lung Transplantation in a Patient With Hereditary Hemochromatosis

Suicide left ventricle (SLV) is a rare cause of hemodynamic collapse due to dynamic left ventricular outflow tract (LVOT) obstruction, usually after surgical or transcatheter aortic valve replacement. We report a 54-year-old man with hereditary hemochromatosis undergoing bilateral lung transplantation. Following the weaning of venoarterial extracorporeal membrane oxygenation, he developed acute severe hypotension refractory to norepinephrine, vasopressin, and epinephrine. Intraoperative transesophageal echocardiography demonstrated a small left ventricular cavity, systolic anterior motion of the mitral valve, and LVOT obstruction, consistent with SLV. Subsequent treatment with very high-dose phenylephrine reversed and stabilized his hemodynamics, and the patient was ultimately discharged home with recovery of cardiac and pulmonary function. This case report presents an unusual occurrence of SLV in the absence of aortic valve intervention and highlights the key importance of clinical vigilance, early detection, and prompt appropriate treatment in this rare but life-threatening situation.