When the heart becomes suicidal: A case of severe LVOT obstruction after TAVI

C. Schulz (Hamburg)¹, F. J. Brunner (Hamburg)², L. Waldschmidt (Hamburg)³, M. Patten-Hamel (Hamburg)³, A. Schäfer (Hamburg)⁴, S. Pecha (Hamburg)¹, N. A. Sörensen (Hamburg)⁵, S. Blankenberg (Hamburg)², N. Schofer (Hamburg)^3
1Universitäres Herz- und Gefäßzentrum Hamburg Hamburg, Deutschland; ²Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; ³Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; ⁴Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Herz- und Gefäßchirurgie Hamburg, Deutschland; ⁵Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Kardiologie Hamburg, Deutschland

Transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of aortic stenosis, offering a minimally invasive alternative to surgical aortic valve replacement. However, TAVI can occasionally lead to complications, including the rare, so-called "suicide ventricle" phenomenon with severe left ventricular outflow tract (LVOT) obstruction. This case report describes a 88-year-old woman who developed severe LVOT obstruction following a successful TAVI procedure, complicated by septal anterior motion (SAM) of the mitral valve and resulting severe mitral regurgitation. Despite initial intensive medical management, her symptoms persisted, necessitating transcoronary ablation of septal hypertrophy (TASH) as a salvage procedure. TASH, typically used in hypertrophic obstructive cardiomyopathy, successfully reduced the LVOT gradient and relieved symptoms. This case highlights the importance of preoperative identification of risk factors for LVOT obstruction, awareness of this complication, and an experienced multidisciplinary team in the management of TAVI-associated complications.