Diagnosis and surgical management of subaortic stenosis and mitral valve systolic anterior motion

• Published in: The Journal of heart valve disease Vol. 22; no. 4; pp. 599 - 602
• Main Authors: Choi, Andrew D, Ahmad, Soha, Mathias, Martin, Boyce, Steven, Goldstein, Steven, Morrissey, Richard
• Format: Journal Article
• Language: English
• Published: England 01-07-2013
• Subjects: Aortic Valve - physiopathology; Aortic Valve - surgery; Cardiac Surgical Procedures - methods; Discrete Subaortic Stenosis - complications; Discrete Subaortic Stenosis - diagnosis; Discrete Subaortic Stenosis - physiopathology; Discrete Subaortic Stenosis - surgery; Echocardiography, Transesophageal; Female; Heart Failure - etiology; Heart Failure - physiopathology; Humans; Intraoperative Care - methods; Middle Aged; Mitral Valve - physiopathology; Mitral Valve - surgery; Severity of Illness Index; Treatment Outcome; Ventricular Outflow Obstruction - diagnosis; Ventricular Outflow Obstruction - etiology
• ISSN: 0966-8519

The case is reported of a patient with a previously undiagnosed cause of severe congestive heart failure (CHF) caused by the presence of a discrete subaortic stenosis (SAS) from a subvalvular membrane (SVM). The clinical decision making was complicated by the concurrent presence of systolic anterior motion (SAM) of the mitral valve leaflet. Due to the limitations and eventual failure of physiologically opposing medical management strategies, the patient eventually required an open-heart surgical approach and underwent intraoperative SVM resection. A persistent intraoperative left ventricular outflow tract (LVOT) gradient of 50 mmHg due to SAM prompted mitral valve replacement, which resulted in a complete resolution of the LVOT gradient and symptoms. In this extremely rare scenario of SAS and SAM, when SVM resection is thought to be inadequate to relieve LVOT obstruction due to the concurrent presence of SAM, mitral valve replacement represents a reasonable therapeutic approach.