Unusual Manifestation of Subaortic Membrane
A 52-year-old man complained of dyspnea on exertion for 1 month. On auscultation, a grade 3/6 to-and-fro murmur was heard at the left lower sternal border and was well transmitted to the apex. Fig 1⇓ is the transesophageal echocardiographic image of this patient at that time. Figs 2⇓ and 3⇓ were produced by cardiac catheterization. There was no significant pressure gradient among aorta, subaortic chamber, and left ventricle.
The patient underwent open-heart surgery several days later.Surgery revealed a 1×2-cm defect at the right coronary sinus of Valsalva and a huge subaortic membrane (10×20 cm) adhering to the right coronary cusp and interventricular septum (Fig 4⇓). There was an orifice in the subaortic membrane for communicating with the left ventricle.
The aortic valve was replaced, and the subaortic membrane was successfully excised. The postoperative course was smooth, and the patient was discharged.
Reprint requests to Jyh-Hong Chen, MD, PhD, Department of Internal Medicine, National Cheng Kung University Hospital, 138, Sheng-Li Rd, Tainan, 70428, Taiwan.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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