Discrete subaortic stenosis in an adult patient

Year 2016, Volume: 2 Issue: 1, 66 - 70, 04.03.2016

Kadir Kaan Ozsin , Faruk Toktas , Umut Serhat Sanri , Senol Yavuz

https://doi.org/10.18621/eurj.2016.2.1.66

Cited By: 5

Abstract

Discrete subaortic stenosis is an unusual cause of the left ventricular outflow tract obstruction in the adults and characterized by a discrete subaortic membrane. A 52-year-old female patient presented with chief complaints of progressive dyspnoea, chest pain and fatigue. Echocardiographic study showed a discrete fibromembranous ridge located in the subaortic region, which resulted in severe subaortic stenosis, with a mild aortic regurgitation and a mean gradient of 65 mmHg. She underwent surgical resection of the subaortic membrane without any complications. The postoperative course was uneventful, and she was discharged from hospital on the 7th postoperative day. At one-year postoperative follow-up, the patient was doing well without recurrence on echocardiogram. A close follow-up is mandatory for a possible recurrence despite sufficient surgical resection.

Keywords

Aortic valve, discrete subaortic stenosis; echocardiography; surgery

References

• Marasini M, Zannini L, Ussia GP, Pinto R, Moretti R, Lerzo F, et al. Discrete subaortic stenosis: incidence, morphology and surgical impact of associated subaortic anomalies. Ann Thorac Surg. 2003 Jun;75(6):1763-8.
• Erdal AC, Silistreli E, Catalyurek H, Albayrak G, Aykut K, Acıkel U. [Timing of surgical treatment in subaortic stenosis]. Turk Gogus Kalp Dama. 2004 Jul;12(3):169-71. [Article in Turkish]
• van der Linde D, Takkenberg JJ, Rizopoulos D, Heuvelman HJ, Budts W, van Dijk AP, et al. Natural history of discrete subaortic stenosisin adults: a multicentre study. Eur Heart J. 2013 Jun;34(21):1548-56.
• Oliver JM, Gonzalez A, Gallego P, Sanchez-Recalde A, Benito F, Mesa JM. Discrete subaortic stenosis in adults: Increased prevalence and slow rate of progression of the obstruction and aortic regurgitation. J Am Coll Cardiol. 2001 Sep;38(3):835-42.
• Foker JE. Outcomes and questions about discrete subaortic stenosis. Circulation. 2013 Apr 9;127(14):1447-50.
• Butany J, Vaideeswar P, David TE. Discrete subaortic membranes in adults--a clinicopathological analysis. Cardiovasc Pathol. 2009 Jul-Aug;18(4):236-42.
• Weymann A, Schmack B, Rosendal C, Karck M, Szabó G. Surgical management of subaortic stenosis. Ann Thorac Cardiovasc Surg. 2013 Nov;19(5):390-3.
• Qureshi A, Awuor S, Martinez M. Adult presentation of subaortic stenosis: another great hypertrophic cardiomyopathy mimic. Heart Lung Circ. 2015 Jan;24(1):e7-e10.
• Silbiger JJ. The role of shear stress in the pathogenesis of discrete subaortic stenosis: implications for surgical treatment. J Heart Valve Dis. 2011 Mar;20(2):123-8.
• Huang JJ1, Azakie A, Russell IA. Echo rounds: discrete subvalvular aortic stenosis. Anesth Analg. 2010 Apr 1;110(4):1003-5.
• Hraska V, Photiadis J, Arenz C. Surgery for subvalvar aortic stenosis -- resection of discrete subvalvar aortic membrane. Multimed Man Cardiothorac Surg. 2007 Jan 1;2007(723):mmcts.2006.002303.
• Yap SC, Roos-Hesselink JW, Bogers AJ, Meijboom FJ. Steepened aortoseptal angle may be a risk factor for discrete subaortic stenosis in adults. Int J Cardiol. 2008 May 7;126(1):138-9.
• Kanemitsu S, Yamamoto K, Shimono T, Shimpo H. Discrete subaortic stenosis 37 years after repair of a ventricular septal defect. Interact Cardiovasc Thorac Surg. 2012 May;14(5):683-5.
• van der Linde D, Roos-Hesselink JW, Rizopoulos D, Heuvelman HJ, Budts W, van Dijk AP, et al. Surgical outcome of discrete subaortic stenosis in adults: a multicenter study. Circulation. 2013 Mar 19;127(11):1184-91, e1-4.
• Etnel JR, Takkenberg JJ, Spaans LG, Bogers AJ, Helbing WA. Paediatric subvalvular aortic stenosis: a systematic review and meta-analysis of natural history and surgical outcome. Eur J Cardiothorac Surg. 2015 Aug;48(2):212-20.