JACC. Case reports · 2026
Dual-Level Left Ventricular Outflow Tract Obstruction in an Adult.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Roufeh Elliot, Hindosh Ziad, Lee Joshua, Wolfsohn Jesse, Koppula Anthony S
Аннотация
BACKGROUND: Discrete subaortic membranes are an uncommon cause of left ventricular outflow tract (LVOT) obstruction in adults and may coexist with aortic valve disease.
CASE SUMMARY: A 50-year-old man presented with acute decompensated heart failure. Transthoracic echocardiography showed reduced ejection fraction (30%-35%) and demonstrated severe calcific aortic stenosis with regurgitation. Transesophageal echocardiography revealed a discrete subaortic membrane causing additional subvalvular obstruction, consistent with dual-level LVOT obstruction. Invasive hemodynamics confirmed advanced afterload-mediated heart failure. The patient underwent surgical membrane resection and mechanical valve replacement with subsequent clinical and hemodynamic improvement.
DISCUSSION: Coexisting subvalvular and valvular obstruction is uncommon in adults and may present diagnostic challenges. Multimodality imaging is essential to differentiate obstruction levels and guide surgical management.
TAKE-HOME MESSAGE: Comprehensive multimodality imaging is essential to identify dual-level LVOT obstruction and ensure correction of both valvular and subvalvular disease.
CASE SUMMARY: A 50-year-old man presented with acute decompensated heart failure. Transthoracic echocardiography showed reduced ejection fraction (30%-35%) and demonstrated severe calcific aortic stenosis with regurgitation. Transesophageal echocardiography revealed a discrete subaortic membrane causing additional subvalvular obstruction, consistent with dual-level LVOT obstruction. Invasive hemodynamics confirmed advanced afterload-mediated heart failure. The patient underwent surgical membrane resection and mechanical valve replacement with subsequent clinical and hemodynamic improvement.
DISCUSSION: Coexisting subvalvular and valvular obstruction is uncommon in adults and may present diagnostic challenges. Multimodality imaging is essential to differentiate obstruction levels and guide surgical management.
TAKE-HOME MESSAGE: Comprehensive multimodality imaging is essential to identify dual-level LVOT obstruction and ensure correction of both valvular and subvalvular disease.