Subaortic membrane in adults. A brief review of literature apropos of one case

Main Article Content

Katherine Ruiz
Jorge Curotto-Grasiosi
Rogelio A. Machado
Adriana Angel
Diego Alasia
Bruno Peressotti

Keywords

Discrete subaortic stenosis, Three dimensional, echocardiography

Abstract

A 54-year-old man, ex smoker with high blood pressure and a history of possible Wolff-Parkinson-White syndrome was admitted for presenting an episode suggestive of acute coronary syndrome with immediate syncope and left bundle branch block, while performing physical activity. Angioplasty and a drug-eluting stent were performed in the left circumflex artery. Subsequently, Doppler echocardiography disclosed an image suggestive of a subaortic membrane. Given these findings, the patient underwent a 3D transesophageal echocardiogram and a magnetic resonance study, which confirmed the diagnosis of a subaortic membrane. In turn, in the Holter monitoring a paroxysmal pattern of Wolff-ParkinsonWhite was observed. The patient presented three possible causes of syncope. A stress echocardiogram elicited a gradient of 126 mm Hg, which could be possibly related to the syncopal episode that the patient suffered.

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References

Darcin OT, Yagdi T, Atay Y, Egnin C, Levent E, Buket S, et al. Discrete subaortic stenosis: surgical outcomes and follow-up results. Tex Heart Inst J. 2003;30(4): 286-92.

 

Stassano P, Di Tommaso L, Contaldo A, Monaco M, Mottola M, Musumeci A, et al. Discrete subaortic stenosis: long-term prognosis on the progression of the obstruction and of the aortic insufficiency. Thorac Cardiovasc Surg. 2005;53(1):23-7.

 

Edwards JE. Pathology of left ventricular outflow tract obstrucction. Circulation. 1965;31:586-99.

 

Reis RL, Peterson LM, Mason DT, Simon AL, Morrow AG. Congenital fixed subvalvular aortic stenosis. An anatomical classification and correlations with operative results. Circulation. 1971 May;43(5 Suppl):I11-8.

 

Choi JY, Sullivan ID. Fixed subaortic stenosis: anatomical spectrum and nature of progression. Br Heart J. 1991 May;65(5):280-6.

 

Kitchiner D. Subaortic stenosis: still more questions than answers. Heart. 1999 Dec;82(6):647-8.

 

Cape EG, Vanauker MD, Sigfusson G, Tacy TA, del Nido PJ. Potential role of mechanical stress in the etiology of pediatric heart disease: septal shear stress in subaortic stenosis. J Am Coll Cardiol. 1997 Jul;30(1):247-54.

 

Cilliers AM, Gewillig M. Rheology of discrete subaortic stenosis. Heart. 2002 Oct;88(4):335-6.

 

Van Arsdell G, Tsoi K. Subaortic stenosis: at risk substrates and treatment strategies. Cardiol Clin. 2002 Aug;20(3):421-9.

 

Barkhordarian R, Wen-Hong D, Li W, Josen MHenein MHo SY. Geometry of the left ventricular ourflow tract in fixed subaortic stenosis and intact ventricular septum: an echocardiographic study in children and adults. J Thorac Cardiovasc Surg. 2007 Jan;133(1):196-203.

 

Petsas AA, Anastassiades LC, Constantinou EC, Antonopoulos AG. Familial discrete subaortic stenosis. Clin Cardiol. 1998 Jan;21(1):63-5.

 

Lopes R, Lourenço P, Gonçalves A, Cruz C, Maciel MJ. The natural history of congenital subaortic stenosis. Congenit Heart Dis. 2011 Sep-Oct;6(5):417-23.

 

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.

 

Goodkin GM, Tunick PA, Kronzon I. Proximal isovelocity surface area (PISA) in the evaluation of fixed membranous subaortic stenosis. Echocardiography. 2002 Feb;19(2):157-9.

 

Van der Linde D, Takkenberg JJ, Rizopoulos D, Heuvelman HJ, Budts W, van Dijk AP, et al. Natural history of discrete subaortic stenosis in adults: a multicentre study. Eur Heart J. 2013 Jun;34(21):1548-56.

 

Somers VK, Abboud FM. Neurocardiogenic syncope. Adv Intern Med. 1996;41:399-435.

 

Mark, AL. The Bezold-Jarish reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol. 1983 Jan;1(1):90-102.