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Title: Unexpected suicide left ventricle post-surgical aortic valve replacement requiring veno-arterial extracorporealmembrane oxygenation support despite gold-standard therapy: A case report.
Epworth Authors: Lioufas, Peter Andrew
Kelly, Diane
Brooks, Kyle
Other Authors: Marasco, Sylvana
Keywords: Acute Heart Failure
Aortic Valve Replacement
Cardiogenic Shock
Case Report
Extracorporeal Membrane Oxygenation
Suicide Left Ventricle
Mitral Valve Replacement
Transcatheter Aortic Valve Replacement
Persistent Haemodynamic Instability
Critical Care Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Feb-2022
Publisher: Oxford Academic Press
Citation: Eur Heart J Case Rep . 2022 Feb 2;6(2):ytac020
Abstract: Background: Suicide left ventricle is a well-documented phenomenon occurring after valve replacement, however, it is most commonly described in the mitral valve replacement (MVR) and transcatheter aortic valve replacement (TAVR) population. Cases within the surgical aortic valve replacement (SAVR) population usually resolve with optimal medical and interventional therapies. We describe a case of left ventricular suicide following SAVR presenting with persistent haemodynamic instability despite currently accepted medical and surgical therapies. Case summary: A 62-year-old male with severe aortic stenosis presented for SAVR and a MAZE procedure. There were no significant signs of ventricular hypertrophy on preoperative transthoracic echocardiogram (TTE). Intraoperatively, there was mild chordal systolic anterior motion of the mitral valve (SAM) which only occurred when underfilled. During recovery in the intensive care unit, the patient's pulmonary arterial pressures were noted to rise with worsening cardiac output. Subsequent TTE showed severe dynamic left ventricular outflow tract (LVOT) obstruction secondary to SAM. Due to refractory medical management, an alcohol septal ablation was performed. Despite resolution of obstruction, the patient exhibited biochemical signs of systemic hypoperfusion, and thus veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated. Following 72 h of VA-ECMO support, the patient was weaned with complete resolution of biochemical insults. He was subsequently discharged from the hospital without complication. Discussion: Compared to the TAVR population, suicide ventricle post-SAVR is comparatively rare. Patients who exhibit persistent impaired cardiac output postoperatively should be investigated rapidly with echocardiography. Furthermore, resolution of a LVOT obstruction state from procedural intervention may not immediately follow with improved cardiac output, and may require further supportive management.
DOI: 10.1093/ehjcr/ytac020
PubMed URL:
ISSN: 2514 2119
Journal Title: European Heart Journal - Case Reports
Type: Journal Article
Affiliated Organisations: Department of Intensive Care, The Royal Melbourne Hospital, Level 5 Building B, 300 Grattan Street, Parkville, Victoria 3050, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, Victoria 3800, Australia.
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Building 104, Alan Gilbert Building, University of Melbourne, 161 Barry Street, Carlton, Victoria 3010, Australia.
Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
Department of Surgery, Monash University, The Alfred Hospital, Central Clinical School, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia.Department of Surgery, Monash University, The Alfred Hospital, Central Clinical School, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
Appears in Collections:Critical Care

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