Successful Surgical Intervention in Symptomatic Severe Hypertrophic Subaortic Stenosis

Successful Surgical Intervention in Symptomatic Severe Hypertrophic Subaortic Stenosis

Subaortic stenosis is a scarce progressive entity causing left ventricular outflow tract obstruction leading to concentric left ventricular hypertrophy and carrying a considerable risk of morbidity and mortality. We report a 68-year old woman who was symptomatic for more than two years with signs of congestive heart failure and admitted for re-procedural pulmonary vein isolation because of paroxysmal atrial fibrillation. Echocardiography revealed a marked left ventricular outflow tract obstruction due to a fibromuscular membrane just below the aortic valve and moderate aortic valve insufficiency, compatible with a severe subaortic stenosis. Surgical resection of the subaortic membrane, myectomy of the basal septum, bioprosthesis aortic valve replacement and epicardial left atrial appendage closure were successfully performed. The patient was discharged from hospital in good clinical condition. This report is outlining the diagnostic challenge of the rare diagnosis of a symptomatic severe hypertrophic subaortic stenosis in adulthood which is known to carry a considerable risk of morbidity and mortality and surgical intervention as safe therapy of choice in this condition.