Subvalvular aortic stenosis: Comprehensive cardiac evaluation with dual-source computed tomography

Subvalvular aortic stenosis (SAS) represents a fixed obstruction of the left ventricular outflow tract (LVOT) by an endocardial fold, fibrous tissue, or fibromuscular ridge. Echocardiography including color Doppler is the modality of choice to establish the diagnosis and to assess the extent and hemodynamic severity of SAS. We present imaging findings of a cardiac dual-source computed tomographic (CT) examination in a patient with SAS to demonstrate the potential of the noninvasive modality for a comprehensive evaluation of patients with the disease.

Clinical Summary

A 40-year-old woman was referred for follow-up after resection of a SAS 32 years ago. Clinical examination revealed a systolic grade 3/6 heart murmur and electrocardiography (ECG) showed stressinduced ST-segment depressions. Echocardiography demonstrated recurrence of the SAS causing LVOT obstruction (mean systolic pressure gradient 50 mm Hg). In addition, mild aortic regurgitation and prolapse of the anterior mitral valve leaflet were diagnosed. Thus, the patient was advised to undergo surgical resection of the SAS with aortic valve replacement. (…)

Authors:

Paul Stolzmann, MD; Hans Scheffel, MD; Dominique Bettex, MD; Christoph Karlo, Thomas Frauenfelder, MD, René Prêtre, MD; Borut Marincek, MD and Hatem Alkadhi, MD

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J Thorac Cardiovasc Surg. 2007 Jul;134(1):240-1, 241.e1.