Sudden iatrogenic suicidal right ventricle

Abstract

It is important to obtain a good withdrawal pressure tracing while performing cardiac catheterization in cases with right ventricular outflow tract (RVOT) obstruction to document the site and severity of obstruction. However efforts to manipulate the catheter in the RVOT (either to obtain the gradients or to position the catheter for an outflow angiogram) can sometimes precipitate severe dynamic RVOT obstruction with complete cessation of forward flow leading to life threatening hypotension. The following hemodynamic traces highlight this rare phenomenon which needs to be borne in mind at all times while performing cardiac catheterization in such patients.

Right Ventricular Outflow Tract Obstruction in Adults: A Systematic Review and Meta-analysis

“…One hundred and nine articles were retrieved from the bibliographical examination of the 124 retained studies as well as reverse citation of these primary and secondary sources, resulting in a total of 233 studies, summarized in Supplemental Table S1. 10, Supplemental Figure S1 describes the search process in a flow diagram.…”

“…A total of 109 articles were retrieved from the bibliographic examination of the 124 retained studies, as well as reverse citation of these primary and secondary sources, resulting in a total of 233 studies, summarized in Supplemental Table S1 . 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ,…”

“…In patients receiving inotropes, the term “suicide RV” has been used to describe the acute onset of dynamic RVOTO. 10 , 67 , 231 Kirshbom et al provided a very convincing hypothesis explaining this phenomenon. 70 Pulmonary allograft candidates often suffer from chronic pulmonary hypertension, leading to structural changes in the heart.…”

“…66 A single case could be attributed to cardiac catheterization, which iatrogenically precipitated infundibular muscular spasm in a patient with pulmonic stenosis and thus dynamic RVOTO. 10 Six cases were secondary to structures in the heart causing dynamic obstruction solely during systole, with two being attributed to myxomas, 31,219 two due to septal aneurysms 106,227 and another two due to double-chambered right ventricle muscle bundles. 205 The most frequent overall causes of RVOTO irrespective of etiological classification are summarized in Table 2.…”

“…8 There are several etiologies of RVOTO which can be classified according to their pathophysiological mechanism; some of these are congenital, 9 while others are iatrogenic. 10 The mechanism of RVOTO can also be differentiated depending on the location of the obstruction, whether intrinsic 11 or extrinsic 12 to the RVOT, and depending on the persistence of the phenomenon relative to the timing of the cardiac cycle (dynamic during systole or diastole only or persistent throughout the cardiac cycle). 13 To our knowledge, no comprehensive review of the prevalence or etiology of RVOTO in adults has been published.…”