Suicidal Left Ventricle After Transcatheter Aortic Valve Replacement Causing Cardiogenic Shock.

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.