Suicidal Left Ventricle After Transcatheter Aortic Valve Replacement Causing Cardiogenic Shock

22/08/2026

AI Summary

Suicidal left ventricle is a rare, potentially fatal post-TAVR complication caused by dynamic LV outflow tract obstruction after abrupt afterload reduction.
Presents with hypotension, hypoperfusion and cardiogenic shock; echocardiography shows small, hyperdynamic LV with dagger-shaped intraventricular gradient and no prosthetic dysfunction.
Management requires early echocardiographic diagnosis, discontinuation of inotropes, and treatment with volume expansion, vasopressors and beta-blockers for rapid recovery.

JACC Case Rep. 2026 Aug 21:109244. doi: 10.1016/j.jaccas.2026.109244. Online ahead of print.

ABSTRACT

BACKGROUND: 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.

CASE SUMMARY: 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.

DISCUSSION: 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.

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

PMID:42627316 | DOI:10.1016/j.jaccas.2026.109244

Document this CPD