What is suicide right ventricle?

A puppy was referred for echocardiography for suspicion of a PDA, due to a grade six heart murmur. We actually found severe pulmonary stenosis, and you can follow the story of this case in this video:

This case was referred for balloon valvuloplasty, and I was introduced to a term I hadn’t heard before: suicide right ventricle. The referral centre stated that because of the right ventricular hypertrophy – in particular in the infundibular region – there was a significant risk of dynamic obstruction occurring with the sudden drop in valve pressure gradient that would be expected post-dilatation. This is termed ‘suicide right ventricle.’

This life-threatening emergency can occur in both animals and humans immediately post-procedure. Combined with careful monitoring and intervention from the anaesthetic team, beta-blockers prior to intervention can decrease the risk of hypercontractility of the right ventricular outflow tract post-valvuloplasty.

Risk factors which increase the likelihood of developing this condition are:

• A high transvalvular pressure gradient
• Right ventricular hypertrophy
• Infundibular hyperactivity (Aprea et al., 2014).

References

Aprea, F., Clark, L., Whitley, N., Oliveira, P. (2014). Presumed ‘suicidal right ventricle’ in a Cocker Spaniel dog undergoing pulmonary valve balloon dilation and its prevention in an analogous case, Veterinary Anaesthesia and Analgesia, 41, pp.438-441.