Dynamic Left Ventricular Outflow Tract Obstruction Post–Transcatheter Aortic Valve Replacement

Abstract

We describe the first case of successful management of left ventricular outflow tract obstruction developing late after transcatheter aortic valve replacement with right ventricular apical pacing. The possible mechanisms of obstruction resolution are described. ( Level of Difficulty: Advanced. )

Transcatheter aortic valve implantation using coplanar and cuspal overlap techniques in Indian patients

“…Dynamic left ventricular outflow tract obstructions have been reported post surgical valve replacement but post TAVR we could find only a single case report. 32 …”

Overcoming the Obstacle of Suicide Left Ventricle After Transcatheter Aortic Valve Replacement Phenomenon

“…As a result, LV hypercontractility and DIG may develop or worsen, leading to potential resistant circulatory collapse. 3 This phenomenon—called “suicide left ventricle”—should be promptly detected and anticipated. In such cases we could categorize our actions as preventive and therapeutic ( Figure 5 ).…”

Cardiac Arrest During the Medical Management of Left Ventricular Outflow Tract Obstruction Following the Transcatheter Aortic Valve Implantation

“…Systolic anterior motion of the mitral valve (SAM) and left ventricular outflow tract (LVOT) obstruction are complications following transcatheter aortic valve implantation (TAVI) and can lead to hemodynamic collapse [1]. As the mechanism by which these complications occur, it has been suggested that the sudden decrease of LV pressure after TAVI reduces the area of the LVOT and increases flow velocity across the LVOT [2]. From this pathophysiological perspective, medical management for these complications is usually centered on a reduction in LV contractility with negative inotropes, an increase of LV afterload with vasoconstrictors, and an increase of LV preload by fluid infusion [1][2][3].…”

“…As the mechanism by which these complications occur, it has been suggested that the sudden decrease of LV pressure after TAVI reduces the area of the LVOT and increases flow velocity across the LVOT [2]. From this pathophysiological perspective, medical management for these complications is usually centered on a reduction in LV contractility with negative inotropes, an increase of LV afterload with vasoconstrictors, and an increase of LV preload by fluid infusion [1][2][3]. Here, we report a case of cardiac arrest despite effective medical management for SAM and LVOT obstruction following TAVI.…”