A Word of Caution Before Treating Aortic Stenosis in Patients With Concomitant LVOT Obstruction

Ben‐Dor, Itsik; Rogers, Toby; Medranda, Giorgio A.; Medvedofsky, Diego; Weissman, Gaby; Case, Brian C.; Satler, Lowell F.; Waksman, Ron

doi:10.1016/j.jaccas.2022.01.025

Cited by 6 publications

(9 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It was previously reported that the risk factors for SAM and LVOT obstruction after TAVI include female gender, high resting gradient, Brockenbrough-Braunwald-Morrow sign, asymmetric septal hypertrophy, and small LV cavity [ 1 ]. Our patient was deemed to be at high risk for exacerbation of MR and development of LVOT obstruction following TAVI.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient was deemed to be at high risk for exacerbation of MR and development of LVOT obstruction following TAVI. The effectiveness of alcohol septal ablation and transcatheter mitral valve repair as pre-emptive treatment for LVOT obstruction has been implied, but the decision to perform these interventions remains difficult [ 1 ]. Our experience was limited and thus we did not conduct the pre-emptive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Saika,

Wakabayashi,

Ichiyanagi

et al. 2024

Cureus

View full text Add to dashboard Cite

Systolic anterior motion of the mitral valve and left ventricular outflow tract obstruction are complications following transcatheter aortic valve implantation and can lead to hemodynamic collapse. Medical management for those complications is usually centered on a reduction in left ventricular contractility with negative inotropes. An 88-year-old woman underwent transcatheter aortic valve implantation for severe aortic stenosis. Hemodynamic collapse and exacerbation of mitral regurgitation occurred immediately after valve implantation. For suspected left ventricular outflow tract obstruction, medical management centered on negative inotropes was performed. Hemodynamics and left ventricular outflow tract obstruction improved over time; however, the oxygen supply-demand imbalance progressed. On postoperative day 5, the patient suddenly went into pulseless electrical activity. Cardiopulmonary resuscitation was performed for three minutes, resulting in the return of spontaneous circulation. Subsequent refractory hypotension and oxygen supply-demand imbalance improved with continuous infusion of adrenaline, dobutamine, and phenylephrine. Her hemodynamics remained stable after she was weaned off the pressor infusions, and negative inotropes were not required again. In summary, the cause of cardiac arrest was possibly due to excessive negative inotropic effects even though the effects contributed to improvement of left ventricular outflow tract obstruction. Anesthesiologists and intensivists should recognize the risk of cardiac arrest induced by negative inotropic effects and use negative inotropes with rigorous hemodynamic monitoring, even when left ventricular outflow tract obstruction is treated effectively.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Saika,

Wakabayashi,

Ichiyanagi

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…SLV most commonly happens after AVR and has even been reported after mitral valve replacement [ 10 ]. The main predisposing factor to post-SAVR LVOTO is unfavourable LV anatomy.…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Suicide Left Ventricle After Surgical Aortic Valve Replacement

Chraibi¹,

Bakamel²,

Fellat³

et al. 2023

Cureus

View full text Add to dashboard Cite

Suicide left ventricle (SLV) remains an underdiagnosed cause of haemodynamic compromise following surgical or transcatheter aortic valve replacement (AVR). Risk factors include female sex and a small left ventricular cavity with asymmetric septal hypertrophy. We present the case of a 63-year-old woman, with a medical history of diabetes mellitus, arterial hypertension and dyslipidaemia who was diagnosed with severe aortic stenosis with normal left ventricular ejection fraction and concentric hypertrophy. She underwent surgical AVR using a bioprosthetic valve, but a few hours after surgery, she developed sudden cardiogenic shock. An urgent transthoracic echocardiogram was performed showing marked systolic anterior motion of the mitral valve resulting in severe dynamic left ventricular outflow tract obstruction and intraventricular gradient. The diagnosis of SLV was made. The patient was managed conservatively with volume loading and oral beta-blockers and her haemodynamic state improved gradually. She was then discharged after favourable evolution. Medical management of SLV includes volume loading to expand the ventricular volume and beta-blockers for their negative inotrope effect. When medical therapy fails, surgical myectomy or alcohol septal ablation can be proposed to remove the obstacle. Some authors have proposed these procedures as prophylactic measures to prevent SLV in high-risk patients.

show abstract

Acute Hemodynamic Compromise After Transcatheter Aortic Valve Replacement Due to Dynamic Left Ventricle Obstruction: A Systematic Review

Barzallo,

Torrado,

Benites-Moya

et al. 2024

The American Journal of Cardiology

View full text Add to dashboard Cite

A Word of Caution Before Treating Aortic Stenosis in Patients With Concomitant LVOT Obstruction

Cited by 6 publications

References 5 publications

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

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

Conservative Management of Suicide Left Ventricle After Surgical Aortic Valve Replacement

Acute Hemodynamic Compromise After Transcatheter Aortic Valve Replacement Due to Dynamic Left Ventricle Obstruction: A Systematic Review

Contact Info

Product

Resources

About