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The prevalence of discrete subaortic stenosis (SAS) in adults with congenital heart disease (CHD) is 8 to 20%, with a male to female ratio of 2:1. Fixed SAS may be due to a discrete fibrous membrane, a muscular narrowing, or a combination of the two. The discrete form of fibromuscular SAS is most frequently encountered (90%), but the tunnel-type lesions are associated with a greater degree of stenosis. We report the case of a 16-year-old boy scheduled for double valve replacement (DVR) based on the preoperative echocardiographic report of rheumatic heart disease (RHD) with severe aortic stenosis (AS), severe aortic regurgitation (AR) and moderate mitral stenosis (MS), and moderate mitral regurgitation (MR) with severe left ventricular (LV) systolic dysfunction and LV apical clot. Preoperative transthoracic echocardiography (TTE) in the operation theater revealed discrete subaortic membrane (SAM) causing severe LV outflow tract obstruction (LVOTO). The patient underwent open heart surgery with resection of the discrete membrane and removal of apical clot.

journal of perioperative echocardiography

Role of Perioperative Echocardiography in Revision of Assessment: A Condition of Severe Aortic Stenosis leading to Left Ventricular Dysfunction and Apical Clot