Page 26 - Delaware Medical Journal - November 2015
P. 26
Subvalvular Aortic Stenosis
Armin Barekatain, MD, MSc.; Zaher Fanari, MD; Sumaya Hammami, MD, MPH; Wasif Qureshi, MD
Obstruction of the left ventricular outflow tract (LVOT) occurs in six out of 10,000 live births. The obstruction occurs
in the aortic valve level in 71 percent, in subvalvular level in 14 percent, and supravalvular level in 8 percent of cases. Subvalvular aortic stenosis (AS) can be either a fixed stenosis resulting from subaortic membrane or a dynamic stenosis because of hypertrophic cardiomyopathy. Here, we report a patient with subaortic membrane who became symptomatic in her sixth decade of life. Echocardiography is the preferred diagnostic modality. Indications for surgery include symptoms, LVOT gradient of 50 mmHg or more, and development of significant aortic regurgitation.
Introduction
Obstruction of the left ventricular
of 10,000 live births.1 The obstruction occurs in the aortic valve level in 71 percent, in subvalvular level in 14 percent, and supravalvular level in 8 percent of cases.1 Subvalvular aortic subaortic membrane or dynamic because of hypertrophic cardiomyopathy. Here we report a patient with subaortic membrane who became symptomatic in her sixth decade of life.
CASE
A 54-year-old female presented with several months history of chest pain
and dyspnea on exertion. On physical examination she was found to have a grade 3/6 systolic ejection murmur at the left sternal border with no radiation and no thrill. The intensity of the murmur was attenuated with Valsalva maneuver. echocardiogram (TTE) which showed mild left ventricular hypertrophy and normal LV systolic function. The
FIGURE 1
Continuous wave Doppler reveals high LVOT gradients. In the absence of a stenotic aortic valve, Supra- or sub-valvular aortic stenosis should be highly suspected.
continuous wave (CW) Doppler of the aortic valve revealed maximum
pressure gradient of 91 mmHg and mean pressure gradient of 37 mmHg (Figure 1). Color Doppler revealed a mosaic
(Figure 2). Two- dimensional (2D) echocardiography showed morphologically normal anterior motion of the mitral valve nor
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Del Med J | November 2015 | Vol. 87 | No. 11
Abstract
